Severance Pay SANTA MONICA, CALIFORNIA. The Santa Monica Pier is a 100-year-old landmark located at the foot of Colorado Avenue.

Transcription

1 Severance Pay SANTA MONICA, CALIFORNIA The Santa Monica Pier is a 100-year-old landmark located at the foot of Colorado Avenue.

2 ROUTE 66 AT 34 01'19"N '53"W SANTA MONICA, CALIFORNIA Route 66 ends in Santa Monica, California. The Santa Monica Pier, built in 1909, is home to the Looff Hippodrome, an antique carousel declared a National Historic Landmark in This Severance Pay booklet when combined with the separate Other Information booklet serves as your summary plan description (SPD) of the benefits provided under the Phillips 66 Severance Pay Plan. It s an overview of certain terms and conditions, rather than a description of every detail of the plan. It s written in clear, everyday language that s designed to help you understand how the plan works. Every effort has been made to ensure the accuracy of the information provided in this SPD. However, if there s any discrepancy or conflict between this SPD and the terms of the official plan document, the official plan document will control. Phillips 66 reserves the right to amend, change or terminate the plan at any time without notice, at its sole discretion. Nothing in this SPD creates an employment contract between the company or its subsidiaries or affiliates and any employee.

3 SEVERANCE PAY Severance pay. Help for the transition... 2 The big picture... 4 Eligibility and enrollment... 5 Am I eligible?... 5 What if I m on a leave of absence?... 5 Who pays for coverage?... 5 Do I need to enroll?... 5 How do I qualify for benefits?... 6 How the plan works... 8 Your severance benefits... 8 Basic benefit... 8 Supplemental benefits... 8 Calculating your benefit Educational reimbursement General Release of Liability How to file a claim How are benefits paid? Errors or mistakes Waiving benefits What happens if I m rehired I die When does coverage end? Anything else I need to know? Contacts Appendix A Change in Control provisions General information...* Administrative information Plan identification information Plan administration Agent for service of legal process Assignment of benefits Right of recovery If the plan changes or ends Your ERISA rights...* Prudent actions by plan fiduciaries Enforce your rights Claims and appeals procedures...* ERISA plan information...* Glossary...* * Many of our plans have the same or similar terms, which are located in the separate Other Information booklet. It s important that you review both this Severance Pay booklet and the Other Information booklet, which together compose the plan s Summary Plan Description, to fully understand this benefit plan. A couple of technical things The official name of this plan is the Phillips 66 Severance Pay Plan. But in this booklet, we ll just call it the plan. When we say Phillips 66, the company, we or our, we mean Phillips 66 Company and any other subsidiary or affiliated company that has adopted the plan and is a participating employer. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 1

4 Severance pay. Help for the transition. If you are laid off or lose your job at the company as a result of an event such as a reduction in force or job elimination, the company may provide severance benefits that give you a measure of security during your transition to a new job.

5 SEVERANCE PAY Severance benefits may be payable for situations like these: Joe Joe is in a line of business that the company is eliminating next month, and there s no comparable job in another part of the company. Mark Mark is in a location that s being closed and whose employees are being offered jobs in another location in the next state. Mark doesn t qualify for relocation assistance and doesn t want to make the move. Sally Sally works in a support group that is being transitioned to an external provider. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 3

6 SEVERANCE PAY The big picture Severance Pay Plan benefits may include: Severance pay A cash payment, which is based on your pay and years of service with the company. Educational reimbursement Reimbursement for tuition, books and fees for courses that can help you qualify for a new job or career. To receive the highest level of benefits, you ll need to sign a release stating that you won t pursue the company for legal liability for employment-related claims. We talk about that later in this booklet. Of course, severance benefits don t apply in all situations. For example, they don t apply if you re offered a comparable job with the company and turn that job down. See page 6 for details. Don t miss! The Contacts section on page 15 for phone numbers, web and mailing addresses and hours of operations for HR Connections. The separate Other Information booklet, which contains additional important legal and administrative information about the plan s benefits including information regarding what to do if a claim for your benefits is denied. The Glossary, which is located in the Other Information booklet, for details about some of the terms used in this booklet. 4 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

7 Eligibility and enrollment To be eligible for severance benefits, you must be an eligible employee and your layoff must meet the qualifying circumstances shown in How do I qualify for benefits? on page 6. AM I ELIGIBLE? You re eligible if you re: A regular full-time or regular part-time Phillips 66 employee in salary grade 22 or below; On a participating employer s direct U.S. dollar payroll; and Not otherwise excluded from the plan. See page 6. Even if you meet the requirements above, you re not eligible if you re: A temporary, intermittent, contract or leased employee. A store employee. An employee covered by a collective bargaining agreement, unless the agreement expressly provides for participation in the plan. However, even if your collective bargaining agreement specifically provides for coverage under the plan, you re not eligible to participate in the plan while you re on a leave of absence-labor Dispute. WHAT IF I M ON A LEAVE OF ABSENCE? You re not eligible for plan benefits if a notice of layoff is given while you re on a personal leave of absence. For information regarding other types of leaves, please contact HR Connections. If you re on a leave of absence-labor Dispute If you re placed on a leave of absence-labor Dispute, coverage will end on the day the leave begins. Coverage will resume automatically upon your return to work as an eligible employee. WHO PAYS FOR COVERAGE? The company pays the entire cost of the plan employee contributions aren t required or allowed. DO I NEED TO ENROLL? No. Provided you re eligible, participation is automatic. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 5

8 SEVERANCE PAY HOW DO I QUALIFY FOR BENEFITS? You must meet all the qualifying circumstances listed below to qualify for benefits: You re laid off; The company gives you a written notice of layoff; Following the notice of layoff, the company terminates your employment on a date determined by the company; Your termination meets one of the conditions below: You re a salary grade level 20 or below and your termination of employment is either caused by a reduction in force, a job elimination or a corporate event, or is designated as a layoff by the Chief Executive Officer of Phillips 66 Company; You re a salary grade level 21 or 22 and your termination of employment is prior to a Change in Control* and is designated as a layoff by the Chief Executive Officer of Phillips 66 Company; or Your termination of employment is on or after a Change in Control* and is either caused by a reduction in force, a job elimination or a corporate event, or is designated as a layoff by the Chief Executive Officer of Phillips 66 Company or its successor; You re an employee on your date of layoff; and You have completed or will complete one year of service as of your date of layoff. For plan purposes, a corporate event includes a sale of assets, sale of stock, joint venture, outsourcing, etc. See the Glossary, located in the Other Information booklet, for more complete details. * See Appendix A Change in Control provisions on page 16 for details. You re NOT eligible for benefits if Even if you ve received a notice of layoff, you re not eligible for plan benefits if: You re an eligible employee, and your subsequent transfer to a member of the ConocoPhillips control group is directly related to the Phillips 66 spin-off. Your employment is terminated as a result of a corporate event, and a successor employer offers you a job with comparable pay. For this purpose, comparable pay means at least 80% of your prior regular base pay, including regularly scheduled overtime, but not including overtime due to the 19/30 program. Your employment is terminated as a result of a corporate event, and you accept any job offered by a successor employer. You re on inactive disability status as of your date of layoff. You re on a personal leave of absence as of your date of layoff. You re discharged (terminated for cause). You resign as of a date prior to the layoff date specified in the notice of layoff. Your employment is terminated because you failed to accept any of the following jobs within seven calendar days of the offer: A job offered by an employer at comparable pay and at a comparable employment level, but in a different geographical area, for which you would receive relocation assistance. A job offered by an employer at comparable pay and at a comparable employment level and in the same geographical area. A transfer job at comparable pay offered by an affiliate that isn t considered an employer under this plan, but which is made based on a mutual agreement between the company and the affiliate offering the job. 6 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

9 You accept any transfer job offered by an affiliate that isn t considered an employer under this plan, but which is made based on a mutual agreement between the company and the affiliate offering the job. Please note that you may be required to provide the company with additional information (including proposed pay) relating to any job offer by another employer. In addition to the above list, you re not eligible for severance benefits if: You accepted benefits under any other layoff plan, severance plan or similar program maintained by the company (other than a retention bonus). You received layoff pay or termination pay under a negotiated working agreement or collective bargaining agreement. You re an hourly employee covered by a collective bargaining agreement or working policy, and you haven t exhausted your rights to accept a job in place of less senior employees in the same work unit. At the time benefits would be paid, you owe money to the company including an obligation to repay benefits received from this plan or any other severance plan of the company and you haven t made an arrangement that s satisfactory to the company to repay that obligation. You waived benefits under this plan. Here are some examples of people who aren t eligible for severance pay: Sherry is leaving her job voluntarily to work for another company. Mike is leaving his job voluntarily to go back to school, and he doesn t have a new job yet. Brandon was terminated for breaking the law on company premises. Cheryl is part of a group that was bought by another energy company in a nearby location, and she turned down a job at the new company at the same pay. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 7

10 SEVERANCE PAY How the plan works If you re laid off and meet all the eligibility requirements shown under How do I qualify for benefits? on page 6, the plan may provide the following benefits: Severance benefit Basic benefit Four weeks pay. No Supplemental benefit Educational reimbursement Three weeks pay for each year of service, up to a maximum of 60 weeks pay, minus the basic benefit. Up to $2,000 for approved tuition, required fees and books for courses that can reasonably be expected to lead to your re-employment. You must complete your courses and make your requests for reimbursement no later than the first anniversary of your date of layoff. General Release of Liability required? Yes Yes We talk about these benefits in this section and also give you basic information about the General Release of Liability. YOUR SEVERANCE BENEFITS You may be eligible for up to three types of severance benefits basic, supplemental and educational. We ll start with the basic benefit. Basic benefit The basic benefit is four weeks pay. If you re eligible, you ll receive this payment even if you don t sign a General Release of Liability. Supplemental benefits You re eligible to receive supplemental benefits if: You re eligible for a plan benefit; and You sign and return a General Release of Liability. This legally-binding form releases the company from liability for employment-related claims, meaning that you agree that you won t pursue the company in court for additional employment-related claims related to your employment or layoff. Your completed Release must be in a form acceptable by the company, and must be signed and returned within 60 days after your date of layoff. Supplemental benefits are paid in addition to the basic benefit. The benefit is three weeks pay for each year of service, minus the four weeks pay that will be paid as a basic benefit. The maximum plan benefit (basic + supplemental) is 60 weeks. 8 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

11 The table below shows what you could receive in basic and supplemental benefits, depending on your years of service. (If you don t sign and return a Release, your benefit would be limited to four weeks pay, regardless of your service.) Total layoff pay (basic + supplemental benefits) Years of service Number of weeks pay Less than (basic benefit) or more 60 Years of service includes all service you had at ConocoPhillips prior to the spin-off of Phillips 66, as well as service with Phillips 66 since the spin-off. Limit on supplemental benefits Your supplemental benefits may be reduced if the total of your basic + supplemental benefits is more than two times the maximum annual pay that can be considered for retirement plan purposes in the calendar year before the calendar year in which your layoff occurs. If this happens, the company will let you know. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 9

12 SEVERANCE PAY Calculating your benefit As shown in the following examples, your benefit depends on whether you sign and return the General Release of Liability. Here s how severance pay is calculated for Pat, a Phillips 66 employee who had 10 years of service when he was laid off. Here s how to calculate your severance pay benefit First, calculate your weekly pay Your weekly pay is based on your pay in effect on your date of layoff. If you re a salaried employee, it s your monthly pay divided by * If you DON T sign and return a General Release of Liability And here s how Pat s severance pay is calculated Pat s monthly pay is $2,600. His weekly pay is $600 ($2, ). You ll get the basic benefit of 4 weeks pay. $ 600 (weekly pay) x 4 (total weeks of basic benefit) = $ 2,400 (Pat s basic benefit) If you DO sign and return a General Release of Liability** You ll get the basic + supplemental benefit, which is the number of weeks pay shown in the table on page 9. Pat had 10 years of service. That means he gets 30 weeks severance pay. $ 600 (weekly pay) x 30 (# of weeks of severance pay) = $ 18,000 (Pat s basic + supplemental benefit) Now, imagine that you (and Pat) had 25 years of service when you left the company Assuming you sign the General Release of Liability, you ll get maximum basic + supplemental benefit, which is 60 weeks pay (as shown in the table on page 9). In this instance, Pat had 25 years of service. That means he gets 60 weeks severance pay. $ 600 (weekly pay) x 60 (# of weeks of severance pay) = $ 36,000 (Pat s basic + supplemental benefit) * Please see weekly pay in the Glossary, located in the Other Information booklet, for more detailed information and to see how weekly pay is calculated for hourly employees. ** The General Release of Liability must be timely signed and returned to the Plan Administrator or your Human Resources representative and must not be revoked. Please see the General Release of Liability section on page PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

13 Educational reimbursement The plan s supplemental benefits also include an educational reimbursement of up to $2,000 for tuition, required fees and books. This reimbursement is for course work that will help you find a new job. Human Resources must approve your proposed classes. To qualify for educational reimbursement, you must do all of the following: Sign a General Release of Liability (more about that below). Within 90 days after layoff, submit a plan of course studies that can reasonably be expected to help you find a new job. Enroll in classes from an accredited college, university, trade school or in classes that are part of a certified/licensed instructional program. Finish all classes and request reimbursement no later than the first anniversary of your date of layoff. You ll need to provide evidence that you ve finished your classes as well as receipts or bills for tuition and books. Note: The plan won t pay any educational costs that are already reimbursed by any federal, state or local governmental agency or by any private source. GENERAL RELEASE OF LIABILITY To receive supplemental or educational benefits, you must sign a General Release of Liability and send it to the Plan Administrator or your Human Resources representative by the 60th calendar day after your date of layoff. If the 60th calendar day is a scheduled company holiday, the Release must be received by the next business day. A faxed copy of the Release will be accepted, as long as it is followed by the original signed Release. The Release is revocable during the seven-day period after you sign it. After seven days, it s irrevocable, and you can t change your mind. You won t be able to receive payments for supplemental or educational benefits until the seven-day period has passed. If you die If you die after receiving a notice of layoff but before signing the General Release of Liability, your spouse or your estate s representative must sign the Release and return it by the deadline if they want supplemental benefits to be paid. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 11

14 SEVERANCE PAY Either you, your surviving spouse, a representative of your estate (if you ve died) or the company can request that the Plan Administrator extend the deadline for submitting the Release. The Plan Administrator: Will approve such extensions if the additional time was needed to clarify issues relating to the scope or coverage of the Release. Will not approve the extension if it s being made only to extend the time that benefit payments would otherwise be made under the plan. If the Plan Administrator doesn t receive the signed Release by the required deadline (including any approved extensions), you (or your spouse or estate) won t be entitled to supplemental benefits or educational reimbursement benefits. The plan would pay only the basic benefit. How to file a claim Severance benefits are paid automatically, so you don t need to file a claim to receive them. However, you may file a claim if you believe you should have received severance benefits but did not or if you believe the amount of your benefit was less than you should have received. The claim must be provided in writing to the Plan Administrator within 24 months after your employment end date. If a claim is denied, you have specific rights and responsibilities for appealing the denial. See the separate Other Information booklet for details. 12 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

15 How are benefits paid? All severance benefits basic, supplemental and educational reimbursement will be paid to you in a lump-sum cash payment. Any required federal and/or state taxes will be withheld from your payments. If you re an expatriate employee, withholding will be for assumed taxes. ERRORS OR MISTAKES If you or the company makes a mistake, the payment may be adjusted in the future or you may have to repay some of the amount you already received. This could happen if: The company or its agents or representatives make a mistake relating to eligibility for benefits or how much your benefit should be; or You or your beneficiary make a misstatement (or fail to state an important fact) in an application or claim for benefits or in an information request. WAIVING BENEFITS You may waive (or refuse) benefits under the plan by filing a written waiver with the Plan Administrator. The waiver must be in proper form, must apply to all benefits payable under the plan, and must be irrevocable. In other words, you can t change your mind. Contact the Plan Administrator for details. What happens if I M REHIRED If you re rehired after you ve already received severance benefits from this plan or a predecessor plan, you do not repay those benefits. However, your years of service for any future severance benefits will be determined using your Severance Service Date (SSD) under the company s Service Recognition Policy, which may be adjusted to reflect your earlier severance benefits. In addition, you ll become eligible for benefits again only if you: Satisfy the rules for eligibility to be a participant based on your service after you are rehired; and Satisfy the rules to receive benefits. For example Here s how your years of service would be calculated if you were: Laid off after 20 years of service and received 60 weeks of layoff pay; Rehired 25 weeks after your initial layoff; and then Were laid off again 5 years later. In this instance, you would not repay any of your initial severance pay. However, your severance pay for your second period of employment would be calculated based on your 5 years of service following your rehire rather than on your combined 25 years of service. I DIE If you die after receiving notice of layoff but before receiving the layoff pay, the severance payment will be made to your surviving spouse, or to your estate if you re not married at the time of death. To receive supplemental benefits, your spouse or your estate s representative must sign a General Release of Liability and return it by the deadline. SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 13

16 SEVERANCE PAY When does coverage end? Your Severance Pay Plan coverage ends on the day: Your employment ends. You re no longer eligible (see page 5). You go out on a leave of absence-labor Dispute. You go out on a personal leave of absence, unless the leave is related to approved FMLA or military service. Phillips 66 stops offering this coverage. Anything else I need to know? This Severance Pay booklet is intended to help you understand how your severance benefits work, but there s also a lot of other important legal information related to the plan. That information is included in the separate Other Information booklet. In addition to administrative and ERISA information, the Other Information booklet is your source for information on what to do if a claim is denied, and more! And remember, this Severance Pay booklet and the Other Information booklet work together to serve as your summary plan description (SPD). 14 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

17 Contacts For information on Contact Phone/Operating Hours Plan provisions Benefit claims Phillips 66 HR Connections P.O. Box 2400 Bartlesville, OK Web: hr.phillips66.com Online for active employees: From HR Express under Express Help, select Contact Us Manager, Benefits Phillips 66 Company c/o Benefits Department P.O. Box 4428 Houston, TX (855) or (918) :00 a.m. to 6:00 p.m. Central time, Monday Friday, except U.S. company holidays (832) SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 15

18 SEVERANCE PAY Appendix A Change in Control provisions The following definitions apply to the Change in Control provisions of the official plan document. Affiliate Associate Beneficial owner Has the meaning ascribed to such term in Rule 12b-2 of the General Rules and Regulations under the Exchange Act, as in effect on March 13, With reference to any person: (a) Any corporation, firm, partnership, association, unincorporated organization or other entity (other than the company or a subsidiary of the company) of which such person is an officer or general partner (or officer or general partner of a general partner) or is, directly or indirectly, the beneficial owner of 10% or more of any class of equity securities; (b) Any trust or other estate in which such person has a substantial beneficial interest or as to which such person serves as trustee or in a similar fiduciary capacity; and (c) Any relative or spouse of such person, or any relative of such spouse, who has the same home as such person. With reference to any securities, any person if: (a) Such person or any of such person s affiliates and associates, directly or indirectly, is the beneficial owner of (as determined pursuant to Rule 13d-3 of the General Rules and Regulations under the Exchange Act, as in effect on March 13, 2004) such securities or otherwise has the right to vote or dispose of such securities, including pursuant to any agreement, arrangement or understanding (whether or not in writing); provided, however, that a person shall not be deemed the beneficial owner of, or to beneficially own, any security under this subsection (a) as a result of an agreement, arrangement or understanding to vote such security if such agreement, arrangement or understanding: (i) Arises solely from a revocable proxy or consent given in response to a public (i.e., not including a solicitation exempted by Rule 14a-2(b)(2) of the General Rules and Regulations under the Exchange Act) proxy or consent solicitation made pursuant to, and in accordance with, the applicable provisions of the General Rules and Regulations under the Exchange Act; and (ii) Is not then reportable by such person on Schedule 13D under the Exchange Act (or any comparable or successor report); (continued) 16 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

19 Beneficial owner (continued) (b) Such person or any of such person s affiliates and associates, directly or indirectly, has the right or obligation to acquire such securities (whether such right or obligation is exercisable or effective immediately or only after the passage of time or the occurrence of an event) pursuant to any agreement, arrangement or understanding (whether or not in writing) or upon the exercise of conversion rights, exchange rights, other rights, warrants or options, or otherwise; provided, however, that a person shall not be deemed the beneficial owner of, or to beneficially own : (i) Securities tendered pursuant to a tender or exchange offer made by such person or any of such person s affiliates or associates until such tendered securities are accepted for purchase or exchange; or (ii) Securities issuable upon exercise of exempt rights; or (c) Such person or any of such person s affiliates or associates: (i) Has any agreement, arrangement or understanding (whether or not in writing) with any other person (or any affiliates or associates thereof) that beneficially owns such securities for the purpose of acquiring, holding, voting (except as set forth in the proviso to subsection (a) of this definition) or disposing of such securities; or (ii) Is a member of a group (as that term is used in Rule 13d-5(b) of the General Rules and Regulations under the Exchange Act) that includes any other person that beneficially owns such securities. Provided, however, that nothing in this definition shall cause a person engaged in business as an underwriter of securities to be the beneficial owner of, or to beneficially own, any securities acquired through such person s participation in good faith in a firm commitment underwriting until the expiration of 40 days after the date of such acquisition. For purposes hereof, voting a security shall include voting, granting a proxy, consenting or making a request or demand relating to corporate action (including, without limitation, a demand for a stockholder list, to call a stockholder meeting or to inspect corporate books and records) or otherwise giving an authorization (within the meaning of Section 14(a) of the Exchange Act) in respect of such security. The terms beneficially own and beneficially owning shall have meanings that are consistent with this definition of the term beneficial owner. Board The Board of Directors of Phillips 66. (continued) SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 17

20 SEVERANCE PAY Change in Control Occurs if any of the following events occurs: (a) Any person (other than an exempt person) shall become the beneficial owner of 20% or more of the shares of common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding; provided, however, that no Change in Control shall be deemed to occur for purposes of this subsection (a) if such person shall become a beneficial owner of 20% or more of the shares of common stock or 20% or more of the combined voting power of the voting stock of the company solely as a result of (i) an exempt transaction or (ii) an acquisition by a person pursuant to a reorganization, merger or consolidation, if, following such reorganization, merger or consolidation, the conditions described in clauses (i), (ii) and (iii) of subsection (c) of this definition are satisfied; (b) Individuals who constitute the Board (the Incumbent Board ) cease for any reason to constitute at least a majority of the Board; provided, however, that any individual becoming a director whose election, or nomination for election by the company s shareholders, was approved by a vote of at least a majority of the directors then comprising the Incumbent Board shall be considered as though such individual were a member of the Incumbent Board; provided, further, that there shall be excluded, for this purpose, any such individual whose initial assumption of office occurs as a result of any actual or threatened election contest that is subject to the provisions of Rule 14a-11 of the General Rules and Regulations under the Exchange Act; (c) The company shall consummate a reorganization, merger, or consolidation, in each case, unless, following such reorganization, merger, or consolidation: (i) 50% or more of the then outstanding shares of common stock of the corporation resulting from such reorganization, merger, or consolidation and the combined voting power of the then outstanding voting stock of such corporation are beneficially owned, directly or indirectly, by all or substantially all of the persons who were the beneficial owners of the outstanding common stock immediately prior to such reorganization, merger, or consolidation in substantially the same proportions as their ownership, immediately prior to such reorganization, merger, or consolidation, of the outstanding common stock; (ii) No person (excluding any exempt person or any person beneficially owning, immediately prior to such reorganization, merger, or consolidation, directly or indirectly, 20% or more of the common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding) beneficially owns, directly or indirectly, 20% or more of the then outstanding shares of common stock of the corporation resulting from such reorganization, merger, or consolidation or the combined voting power of the then outstanding voting stock of such corporation; and (iii) At least a majority of the members of the board of directors of the corporation resulting from such reorganization, merger, or consolidation were members of the Incumbent Board at the time of the initial agreement or initial action by the Board providing for such reorganization, merger, or consolidation; or (continued) 18 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

21 Change in Control (continued) Common stock Company Election contest Exchange Act Exempt person Exempt rights (d) (i) The shareholders of the company shall approve a complete liquidation or dissolution of the company unless such liquidation or dissolution is approved as part of a plan of liquidation and dissolution involving a sale or disposition of all or substantially all of the assets of the company to a corporation with respect to which, following such sale or other disposition, all of the requirements of clauses (ii)(a), (B), and (C) of this subsection (d) are satisfied; or (ii) The company shall consummate the sale or other disposition of all or substantially all of the assets of the company, other than to a corporation, with respect to which, following such sale or other disposition, (A) 50% or more of the then outstanding shares of common stock of such corporation and the combined voting power of the voting stock of such corporation is then beneficially owned, directly or indirectly, by all or substantially all of the persons who were the beneficial owners of the outstanding common stock immediately prior to such sale or other disposition in substantially the same proportion as their ownership, immediately prior to such sale or other disposition, of the outstanding common stock, (B) no person (excluding any exempt person and any person beneficially owning, immediately prior to such sale or other disposition, directly or indirectly, 20% or more of the common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding) beneficially owns, directly or indirectly, 20% or more of the then outstanding shares of common stock of such corporation and the combined voting power of the then outstanding voting stock of such corporation, and (C) at least a majority of the members of the board of directors of such corporation were members of the Incumbent Board at the time of the initial agreement or initial action of the Board providing for such sale or other disposition of assets of the company. The common stock, par value $.01, of the company. Shall mean Phillips 66 Company. A solicitation of proxies of the kind described in Rule 14a-12(c) under the Exchange Act. The Securities Exchange Act of 1934, as amended. The company, any subsidiary of the company, any employee benefit plan of the company or any subsidiary of the company, and any person organized, appointed or established by the company for or pursuant to the terms of any such plan. Any rights to purchase shares of common stock or other voting stock of the company if at the time of the issuance thereof such rights are not separable from such common stock or other voting stock (i.e., are not transferable otherwise than in connection with a transfer of the underlying common stock or other voting stock), except upon the occurrence of a contingency, whether such rights exist as of March 13, 2004, or are thereafter issued by the company as a dividend on shares of common stock or other Voting Securities or otherwise. (continued) SEVERANCE PAY PHILLIPS 66 BENEFITS FOR THE UNEXPECTED 19

22 SEVERANCE PAY Exempt transaction Person Voting stock An increase in the percentage of the outstanding shares of common stock or the percentage of the combined voting power of the outstanding voting stock of the company beneficially owned by any person solely as a result of a reduction in the number of shares of common stock then outstanding due to the repurchase of common stock or voting stock by the company, unless and until such time as: (a) Such person or any affiliate or associate of such person shall purchase or otherwise become the beneficial owner of additional shares of common stock constituting 1% or more of the then outstanding shares of common stock or additional voting stock representing 1% or more of the combined voting power of the then outstanding voting stock; or (b) Any other person (or persons) who is (or collectively are) the beneficial owner of shares of common stock constituting 1% or more of the then outstanding shares of common stock or voting stock representing 1% or more of the combined voting power of the then outstanding voting stock shall become an affiliate or associate of such person. Any individual, firm, corporation, partnership, association, trust, unincorporated organization or other entity. With respect to a corporation, all securities of such corporation of any class or series that are entitled to vote generally in the election of directors of such corporation (excluding any class or series that would be entitled so to vote by reason of the occurrence of any contingency, so long as such contingency has not occurred). 20 PHILLIPS 66 BENEFITS FOR THE UNEXPECTED SEVERANCE PAY

23 UPDATE: Severance Summary of Material Modifications This is a summary of material modification ( SMM ) to the Phillips 66 Severance Pay booklet as required by law. This SMM, the separate Severance Pay booklet and Other Information booklet together serve as the summary plan description ( SPD ) of the Phillips 66 Severance Pay Plan ( Plan ). This SMM, when combined with the Severance Pay and Other Information booklets, summarizes the official plan text, including amendments through January 1, 2014, and advises you of a change to your SPD. Please read this notice and keep a copy of it in the Updates pocket of your Severance Pay booklet. CHANGES TO DEFINITIONS Effective January 1, 2014, the Glossary, which is located in the Other Information booklet, was amended to define or redefine the term spouse referenced in the Severance Pay booklet. Receipt of this information does not guarantee eligibility. Please refer to the summary plan description (SPD) and any summaries of material modification (SMMs) for details, including information regarding eligibility, benefits provided under the plan, when coverage begins and ends, claims procedures and your legal rights. Phillips 66 reserves the right to amend, change or terminate the plans, any underlying contract or any other program, at any time without notice, at its sole discretion, according to the terms of the plan. January SEVSMM1

24 UPDATE: Severance Summary of Material Modifications This is a summary of material modifications ( SMM ) to the Phillips 66 Severance Pay booklet. This SMM (and any previously issued Severance Pay booklet SMMs), the separate Severance Pay booklet and the separate Other Information booklet together serve as the summary plan description ( SPD ) of the Phillips 66 Severance Pay Plan ( Plan ). The SMMs, when combined with the Severance Pay booklet and Other Information booklet, summarize the official plan text, including amendments through January 1, 2016, and advise you of a change to your SPD. Please read this notice and keep a copy of it in the Updates pocket of your Severance Pay booklet. BASIC BENEFIT CHANGE Effective July 1, 2015, eligible employees with less than one year of service whose layoff meets the Plan s requirements for payment of severance benefits are eligible to receive two weeks pay. ADMINISTRATION CHANGES Effective November 2, 2015, the Manager, Total Rewards replaces the Manager, Benefits as the Plan Administrator. All references to Manager, Benefits are replaced with Manager, Total Rewards. Plan claims must be filed with: Manager, Total Rewards Phillips 66 Company c/o Total Rewards Department P.O. Box 4428 Houston, TX (832) Effective January 1, 2016, all references to the Severance Pay Plan Committee are replaced with the Benefits Committee. Receipt of this information does not guarantee eligibility. Please refer to the summary plan description (SPD) and any summaries of material modifications (SMMs) for details, including information regarding eligibility, benefits provided under the plan, when coverage begins and ends, claims procedures and your legal rights. Phillips 66 reserves the right to amend, change or terminate the plan, any underlying contract or any other program, at any time without notice, at its sole discretion, according to the terms of the plan. January SEVSMM1

25 Other Information WASHINGTON, D.C. Many of the provisions that apply to employee benefit plans like ours are developed in Washington, D.C, the capital of the United States. Effective January 1, 2014

26 38 53'42.4"N 77 02'12.0"W WASHINGTON, D.C. Founded in 1790 with land donated by Maryland and Virginia, the United States capital was named in honor of George Washington and Christopher Columbus. This Other Information booklet is an important part of the summary plan description (SPD) for each of the health and welfare benefit plans available to eligible Phillips 66 employees and retirees. The purpose of the SPDs is to provide you with a summary of each of the health and welfare benefit plans an overview of certain terms and conditions rather than to describe every detail of the plans. Each SPD is written in clear, everyday language that s designed to help you understand how the plans work. Every effort has been made to ensure the accuracy of the information provided in each of the SPDs. However, if there s any discrepancy or conflict between this SPD and the terms of the official plan documents, the official plan documents will control. Phillips 66 reserves the right to amend, change or terminate the plans at any time without notice, at its sole discretion. Nothing in this SPD creates an employment contract between the company or its subsidiaries or affiliates and any employee.

27 OTHER INFORMATION Other Information... 3 How this booklet is organized... 4 General information... 5 Administrative information... 5 Plan identification information... 5 Plan administration... 5 Agent for service of legal process... 5 Assignment of benefits... 6 If the plan changes or ends... 6 If the Severance Pay Plan changes or ends... 7 Your ERISA rights... 7 Medical, dental, vision, Employee Assistance Plan (EAP) and Flexible Spending Plan (FSP)... 9 General information Qualified Medical Child Support Order (QMCSO) Subrogation rights (recovery of benefits paid) Right of recovery COBRA continuation coverage How does COBRA work? What is a qualifying event? For you For your dependent Who is a qualified beneficiary? Disability extension of COBRA coverage What if there s a second qualifying event? Can I change my COBRA coverage? Changing your COBRA elections midyear Enrolled in the plan s COBRA coverage and in another company s plan or Medicare How do I pay for COBRA coverage? When does COBRA coverage end? What if I have questions? USERRA continuation coverage...25 HIPAA privacy rules...26 Claims and appeals procedures Making a decision on your claim Deadlines for decisions on benefit claims Medical, dental, vision, FSP and EAP claims Special rules for medical, dental and EAP urgent care and pre-service claims Improperly filed claims Incomplete urgent care claims Denials of claims How to file an appeal Review of denied claim on appeal Denials of appeals Second level appeal to Appeals Administrator Deadlines for decisions on appeals The Appeals Administrator s decision is final External review Availability of external review Preliminary review Independent Review Organization Final decision Summary of timeline Expedited external review Fraudulent claims ERISA plan information...46 Life, accident and disability plans...49 Right of recovery...49 For Long-Term Disability (LTD) benefits For group life insurance travel assistance benefits For Short-Term Disability (STD) benefits Claims and appeals procedures Information and consents required from you If a claim is denied How to file an appeal If an appeal is denied The Appeals Administrator s decision is final Fraudulent claims ERISA plan information...56 Severance Pay Plan...58 Plan administration...58 Right of recovery...58 Claims and appeals procedures...58 How to file a claim Review of claim denial ERISA plan information...60 Glossary OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 1

28

29 OTHER INFORMATION Other Information We ve given you separate booklets that describe certain aspects of each of the Phillips 66 health and welfare benefit plans who s eligible, what s covered (and not), how to use your benefits, when coverage ends, etc. But those booklets are only part of each plan s summary plan description (SPD). This Other Information booklet contains additional important information related to each of the plans. For example, do you know what to do if your claim for benefits is denied? Or how to continue your medical coverage after you leave Phillips 66? Or what your rights are under the federal ERISA law? That information and more is included in this Other Information booklet. Each of the separate benefit booklets PLUS this Other Information booklet and any summary of material modification make up your complete SPD for each of the Phillips 66 health and welfare benefit plans. Be sure to keep both parts together in a safe place! For convenience, the word plan is used to refer to any and/or all of our health and welfare benefit plans as applicable. Additionally, SPD may be used to refer to this Other Information booklet as well as to the other parts of each plan s summary plan description. When we say Phillips 66, the company, we or our, we mean Phillips 66 Company and any other subsidiary or affiliated company that has adopted the plan and is a participating employer. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 3

30 OTHER INFORMATION How this booklet is organized We ve started with information that applies to all of our health and welfare plans, and then broken everything else up as shown below. See pages For 5 9 Information that applies to all of the Phillips 66 health and welfare benefit plans 9 48 Information specific to the: Phillips 66 Medical and Dental Assistance Plan Employee Medical Plan Employee Dental Plan Employee Vision Plan Retiree Medical Plan Phillips 66 Employee Assistance Plan Phillips 66 Flexible Spending Plan Before-Tax Premiums Health Care Flexible Spending Account Dependent Care Flexible Spending Account Information specific to the: Phillips 66 Group Life Insurance Plan Employee life insurance Occupational accidental death insurance (OAD) Accidental death and dismemberment (AD&D) insurance Phillips 66 Disability Plan Short-term disability Long-term disability Information specific to the: Phillips 66 Severance Pay Plan A Glossary of terms used in the health and welfare benefit plan booklets 4 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

31 General information Unless otherwise noted, the information in this section applies to all of the health and welfare plans listed on page 4. Administrative information PLAN IDENTIFICATION INFORMATION The primary employer (also the Plan Sponsor) and identification number are: Phillips 66 Company c/o Benefits Department P.O. Box 4428 Houston, TX Employer ID#: PLAN ADMINISTRATION Except as otherwise provided in another booklet, the Plan Administrator is: Manager HR Shared Services (HRSS) (or successor) Phillips 66 Company Adams Building 411 S. Keeler Avenue Bartlesville, OK (918) AGENT FOR SERVICE OF LEGAL PROCESS For disputes arising under the plan, legal process may be served on: General Counsel Phillips 66 Company 3010 Briarpark Dr. Houston, TX Service of legal process may also be made upon the Plan Administrator or Claims Administrator at the addresses shown for them. As a named fiduciary, the Plan Administrator: Has discretionary authority to interpret and administer, in its sole discretion, the terms of the plan and make factual determinations. Determines all claims and appeals for eligibility to participate in the plan. Has the power to delegate responsibilities and authority (including discretionary authority) under the plan. Some responsibilities and authority that may be delegated include reviewing claims and appeals, and construing the terms of the plan and insurance contract (if applicable) under the plan. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 5

32 OTHER INFORMATION Assignment of benefits You can t assign your plan benefits. This means that you can t give or transfer (voluntarily or involuntarily) your plan benefits to anyone else. You also can t promise your benefits to anybody. For example, you can t use them as collateral on a loan or as payment on a debt. Any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge or otherwise dispose of any right to benefits payable under a plan shall be void. The company shall not in any manner be liable for, or subject to, the debts, contracts, liabilities, engagements or torts of any person entitled to benefits under a plan. However, a medical or dental provider can file claims on your behalf to be paid back directly from your medical or dental plan. The benefits provided by the Severance Pay Plan cannot be used as security for a loan. However, Severance Pay Plan benefits are subject to garnishment, attachment or other legal process. If your benefits are garnished or attached by legal process, the company will pay the garnished or attached amount in accordance with the decree ordering such payment. Neither the company nor any plan fiduciary is required to investigate the validity of any decree which appears to be valid on its face. In the event you have an outstanding obligation to the participating employer, you may, with the consent of the company, assign all or a portion of your Severance Pay Plan benefit to the participating employer to the extent of such obligation. If the plan changes or ends Phillips 66, acting through action of its Board of Directors or a delegate of the Board of Directors, may amend, modify, suspend or terminate a plan, in part or in whole, at any time and from time to time. Plan changes or terminations apply to benefits that become payable after the date of the change. For example, if plan benefits were changed on January 1, 2014, that change wouldn t affect a claim for covered benefits, services or supplies that were obtained on or before December 31, If a plan changes or ends, you may be able to get COBRA continuation coverage. (This applies to the Phillips 66 Medical and Dental Assistance Plan (excluding the post-65 Medicare-eligible retiree medical options), the EAP and the Health Care Flexible Spending Account only.) Any money remaining in the self-insured components of the Phillips 66 Medical and Dental Assistance Plan will be used to pay medical and dental plan expenses and benefits that are due under the plan. After that, any remaining money may be transferred to a successor plan or, if there is no successor plan, refunded to plan participants. In general, plan assets do not go back to the company. 6 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

33 IF THE SEVERANCE PAY PLAN CHANGES OR ENDS Severance Pay Plan changes or terminations won t affect benefits that are currently payable to you, that is, benefits for which you are eligible and entitled at the time of the change or termination and that have not completely been paid to you. Subsidiary companies that have adopted the plan have the right to decline amendments with respect to their employees participation and to end their participation in the plan at any time. In addition, the Severance Pay Plan can t be amended, terminated, suspended or withdrawn within 24 months after a change in control of the company, with a few exceptions. The plan can be changed: To comply with legal requirements; or If the changes don t negatively affect your eligibility to participate in the plan, the amount of your benefits or other rights under the plan. These restrictions apply to the 24 months after the first event that s considered a change in control. The restrictions end at the end of the 24-month period, even if another change in control occurs. Your ERISA rights As a participant in one or more of the benefit plans listed on page 4, you re entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA), as amended. ERISA provides that all plan participants are entitled to: Receive information about their plan and benefits, as follows: Examine, without charge, at the Plan Administrator s office and at other locations (field offices, plants and selected work sites), all documents governing the plan including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available for review at the Public Disclosure Room of the Employee Benefits Security Administration; Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan descriptions. The Plan Administrator may make a reasonable charge for the copies; and Receive a summary of the plan s annual financial report at no charge (the plan is required by law to furnish each participant with a copy of this summary annual report). OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 7

34 OTHER INFORMATION Continue group health plan coverage (medical, dental, vision, EAP and Health Care Flexible Spending Account), as follows: Continue health care coverage for yourself, your spouse/domestic partner (if applicable) and/or your dependents, if coverage is lost as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the plans for the rules governing your COBRA continuation coverage rights. Reduction or elimination of any exclusionary periods for pre-existing conditions under the group health plan (medical and dental), if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer: º º When you lose coverage under the plan; º º When you become entitled to elect COBRA continuation coverage; º º When your COBRA continuation coverage ends; º º If you request a certificate before losing coverage; or º º If you request a certificate within 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. Prudent actions by plan fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the plan. The people who operate the plan, called fiduciaries of the plan, have a duty to operate the plan prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union or any other person, may fire you or discriminate against you in any way to prevent you from obtaining benefits under the plan or exercising your rights under ERISA. Enforce your rights If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce your rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and don t receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, after following the required claims and appeals procedures and exhausting all administrative remedies described in The Appeal s Administrator s decision is final section of this booklet, you may file suit in federal court. In addition, if you disagree with the plan s decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court. If the plan fiduciaries misuse the plan s money, or if you re discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you re successful, the court may order the person you have sued to pay these costs and fees. If you lose for example, if the court finds your claim is frivolous the court may order you to pay these costs and fees. 8 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

35 Assistance with your questions If you have any questions about the plan, contact the appropriate Plan Administrator or Claims Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, DC You may obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at (866) Medical, dental, vision, Employee Assistance Plan (EAP) and Flexible Spending Plan (FSP) Now let s take a look at the information that applies to each plan. We ll start with: The Phillips 66 Medical and Dental Assistance Plan, which includes employee medical, dental and vision benefits and retiree medical benefits; The Employee Assistance Plan (EAP); and The Flexible Spending Plan (FSP), which includes Before-Tax Premium payments, the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 9

36 OTHER INFORMATION General information QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO) This section does not apply to the post-65 Medicare-eligible retiree medical options. Even though you can t assign your own benefits, a court may assign your benefits in limited situations. One way this is done is through a QMCSO. A QMCSO is a type of court order that gives your biological or legally adopted child the right to be covered by your health coverage (including medical, dental, EAP and your Health Care Flexible Spending Account). For example, a QMCSO might be issued after a divorce to make sure the child is covered under one of the parent s health care plans. Your child must meet the plan s eligibility requirements to be eligible for benefits. Note: QMCSOs don t apply to your grandchildren, nieces, nephews, stepchildren and/or to children of a domestic partner. The court order must satisfy the conditions spelled out under federal law in order to qualify as a QMCSO. You can obtain a copy of these QMCSO procedures without charge at or by calling the Benefits Center. SUBROGATION RIGHTS (RECOVERY OF BENEFITS PAID) The following is a very basic explanation of the subrogation and reimbursement rights that apply to the Consumer Plan, the PPO Plan and the Medicare-Eligible PPO Plan. If subrogation applies to you, it s VERY IMPORTANT that you contact the Plan Administrator and the Claims Administrator for specific instructions and information. Note: This section does not apply to coverage under a medical HMO or to dental, vision, EAP or Flexible Spending Plan benefits. It also does not apply to coverage under the post-65 Medicare-eligible retiree medical options. Suppose you re in a car accident. Or get sick from eating an improperly prepared meal at your favorite restaurant. Or get hurt when a ladder collapses. For these types of situations, subrogation applies if the medical plan paid your medical expenses, but those expenses should have been paid by a third party maybe by an insurance company, or by the restaurant, or by the company that made the ladder. 10 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

37 As used for this provision: You and your means you and/or your covered dependent. A third party can be: Anyone who may be responsible in any way for your condition; Any liability insurance or other insurance that covers you or a third party; or Your own uninsured motorist insurance, underinsured motorist insurance, no-fault insurance or school insurance. A third party excludes: Phillips 66 and any other entity that is a sponsoring employer of the plan. A condition includes an injury, illness, sickness or other similar condition. The plan s rights of subrogation and recovery are described below: The plan may pay (or owe) benefits relating to a condition for which you may be entitled to compensation from a third party. This compensation may include entitlement to payments by that third party to or on your behalf. If this occurs, the plan is subrogated to all of your rights against, claims against and partial or full recoveries from that third party up to the amount paid (or owed) by the plan. This is true regardless of whether you have been fully compensated or made whole for the condition. In addition, if you receive a full or partial recovery from a third party relating to a condition, the plan is entitled to an independent right of immediate and first reimbursement from that recovery (before you or anyone else is paid anything from that recovery), up to the amount paid (or owed) by the plan for that condition. This is true regardless of whether you have been fully compensated or made whole for that condition, regardless of fault or negligence, and regardless of how you obtained that recovery from the third party (for example, by a settlement agreement, court order or otherwise). (The make whole doctrine does not apply.) You ll be responsible for payment of the legal fees associated with your rights of recovery against a third party. The plan s rights of subrogation and reimbursement apply to all amounts that you recover (rather than the amounts remaining after payment of any legal fees and costs). This is true even if, for example, the common fund doctrine provides otherwise. The plan s rights of reimbursement and subrogation apply to the first monies that you re paid or receive, or to which you become entitled, without deductions of any type, including costs or attorney s fees that you incur in order to obtain a payment from a third party with respect to a condition. (The common fund doctrine does not apply.) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 11

38 OTHER INFORMATION The plan may require, before paying any benefits, that you do anything that may be necessary or helpful related to the plan s rights described in this section, including signing (or obtaining signatures on) relevant documents. If the covered dependent with the condition is a minor child, the child s parent or guardian must sign the required documents on behalf of the child. However, the plan shall have rights to reimbursement and subrogation regardless of whether these documents are signed and provided to the plan. You must not do anything to prejudice (or harm) the plan s rights to reimbursement and subrogation. You must cooperate with the plan. If you don t comply with any plan requirement, the plan may withhold benefits, services, payment or credits that otherwise may be due under the plan. You must promptly notify (within 45 days of the filing of a claim against any party for damages resulting from a third party accident) the Plan Administrator of the possibility of obtaining a recovery from a third party for a condition for which the plan has provided benefits (or may be responsible for providing benefits). This is true regardless of whether that recovery may be obtained by a settlement agreement, court order or otherwise. You must not agree to a settlement regarding that condition without first obtaining the written consent of the Plan Administrator or its designee. If you settle a claim with a third party in a way that results in the plan being reimbursed less than the amount of plan benefits related to a condition, or in any way that relieves the third party of future liability for medical costs, the plan may refuse to pay additional benefits for that condition unless the Plan Administrator previously approved the settlement in writing. The plan may enforce its subrogation and reimbursement rights in any of the following ways: The plan may require you to make a claim against any insurance coverage under which you may be entitled to a recovery for a condition. The plan may intervene in any legal action you bring against a third party related to a condition. The plan may bring a legal action against (i) you, (ii) the attorney for you or anyone else, and (iii) any trust (or any other party) holding any proceeds recovered by or with respect to you. The plan shall have a lien on all amounts recovered related to a condition for which it pays (or may owe) benefits, up to the amount of the plan obligations. This is true regardless of whether the amounts recovered are obtained by a settlement agreement, court order or otherwise. The lien applies to a recovery from a third party as defined by the plan. The plan may seek relief from anyone who receives settlement proceeds or amounts collected from judgments related to the condition. This relief may include, but is not limited to, the imposition of a constructive trust and/or an equitable lien. If you or any other person covered under the plan accepts payment from the plan or has plan benefits paid on your (or his or her) behalf, that person does so subject to the provisions of the plan, including the provisions described in this Subrogation Rights section. 12 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

39 The employer, the plan, the Plan Administrator and the Claims Administrator also are entitled to recover any amounts paid under the plan that exceed amounts actually owed under the plan. These excess plan payments may be recovered from you, any other person with respect to whom the payments were made, the person who received the benefit payment, any insurance companies, and any other organization or any other beneficiary of the plan. The employer, the plan, the Plan Administrator and/or the Claims Administrator also may, at its option, deduct the amount of any excess plan payments from any subsequent plan benefits payable to, or on behalf of, you, your spouse, your domestic partner or your dependent, as applicable. The Plan Administrator and/or the Claims Administrator have the authority and discretion to interpret the plan s subrogation and recovery provisions. RIGHT OF RECOVERY For medical, dental and vision benefits If you are paid more than you should have been paid or reimbursed for a claim, or if a claim is paid for ineligible expenses or ineligible dependents, the Claims Administrator may deduct the overpayment from future claims payments due to you under the plan or require the return of the overpayment. For Flexible Spending Plan reimbursements If you are reimbursed more than you should have been from your Health Care Flexible Spending Account and/or Dependent Care Flexible Spending Account, the Claims Administrator may deduct the overpayment from future reimbursements or request reimbursement from you directly. Overpayments not returned will be treated as a taxable distribution. COBRA continuation coverage COBRA continuation coverage does not apply to the post-65 Medicare-eligible retiree medical options. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows qualified beneficiaries to continue medical, dental, vision, the Employee Assistance Plan (EAP) and Health Care Flexible Spending Account (HCFSA) coverage if that coverage is lost due to a qualifying event. The following are examples of events that are considered qualifying events and individuals who are considered qualifying beneficiaries as a result of the qualifying events described: Elena is a Phillips 66 employee who has enrolled herself, her husband and her two children in her Phillips 66 medical and dental coverage. Elena s eldest son just turned 26, which makes him too old to be covered as a dependent. His birthday is the qualifying event. Her son is now a qualified beneficiary. Elena terminates her employment with Phillips 66, and coverage ends for her entire family. Elena s termination of employment is the qualifying event. Elena, her husband and her eligible children are all qualified beneficiaries. Elena and her husband divorce, and her husband is no longer eligible for plan coverage. The divorce is the qualifying event. Her husband is the qualified beneficiary. There s more on qualifying events and qualified beneficiaries beginning on page 17. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 13

40 OTHER INFORMATION Note: Under the Flexible Spending Plan, COBRA is available for the HCFSA only. It s not available for the Dependent Care Flexible Spending Account (DCFSA) or for Before-Tax Premium payments. HCFSA COBRA is also not available to domestic partners and their children. HOW DOES COBRA WORK? COBRA applies to your health care coverage including medical, dental, vision, prescription drugs and mental health and substance abuse. COBRA also applies to EAP and HCFSA contributions and reimbursements. Here s a big-picture look at how it works: Notification and enrollment A qualified beneficiary loses coverage due to a qualifying event (see pages 17 and 18). The plan is notified. The company notifies the plan if your employment ends, your hours are reduced or in the event of your death. You or the qualified beneficiary must notify the Benefits Center for all other qualifying events. You have 65 days* to do this. The COBRA Administrator sends a COBRA Enrollment Notice to the person who lost coverage. You or the qualified beneficiary must elect COBRA within 65 days* to obtain coverage. Generally, each person can make his or her own election, except: Only the employee can make an HCFSA COBRA election. COBRA can t be elected if either of the above deadlines is missed. * The 65-day period begins on the date of the qualifying event or the date of the COBRA Enrollment Notice, if later. (continued) 14 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

41 COBRA coverage options for medical, dental, vision and EAP COBRA coverage options for the Flexible Spending Plan HCFSA At first, you can enroll only in your current medical, dental and vision plan. For example, if you re in the Consumer Plan, you must enroll in the Consumer Plan through COBRA. If you have other dependents you wish to cover under the medical, dental or vision plans, you can also enroll them when you make your COBRA elections. Once you ve enrolled, you can change to a different medical, dental or vision option or add dependents during annual enrollment or following a change in status event as described on page 21. If you elect EAP COBRA coverage, it would cover all eligible dependents that were eligible for the EAP before you lost coverage. If you ve elected EAP COBRA coverage and want it to continue, you don t need to do anything during annual enrollment. Your coverage will remain in effect as long as you re eligible and continue to make required payments. You can cancel coverage for yourself and/or your dependents at any time. You might be allowed to enroll in COBRA medical coverage under this plan and in a group health plan of a different employer or in Medicare; however, some additional provisions will apply. See page 22 for details. (This doesn t apply to COBRA dental or EAP coverage.) Because you forfeit any unused HCFSA contributions, electing HCFSA COBRA gives you time to use up your contributions so you can avoid or reduce this forfeiture. You can continue contributing the same amount to your HCFSA through the end of the calendar year in which your coverage ended. You ll make contributions on an after-tax basis. Any eligible health care expenses you incur during the time you re making HCFSA COBRA contributions are eligible to be reimbursed through your HCFSA. You can choose to not continue your HCFSA through COBRA. If you don t elect HCFSA through COBRA, you can be reimbursed only for expenses incurred through the end of the month in which your coverage ended. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 15

42 OTHER INFORMATION Length of COBRA coverage for medical, dental, vision and EAP Cost of coverage When COBRA ends COBRA for medical, dental, vision and/or EAP coverage can continue for up to: 18 months if the qualifying event was: Your termination of employment with the company (for reasons other than gross misconduct); A reduction in the number of hours you are employed, if there is a loss of coverage under the plan; or Your failing to return to active employment with the company from a family medical leave of absence (FMLA). 29 months if a qualified beneficiary: Is disabled at the time your work hours are reduced or you leave the company or becomes disabled within the first 60 days of an 18-month COBRA period; Qualifies because the qualifying event was your termination of employment or reduction in hours; and Notifies the COBRA Administrator within 65 days of the determination of disability by the Social Security Administration before the end of the 18-month period. This extra time isn t automatic! See page 19 to see what you need to do if you want this extended coverage. 36 months for all other qualifying events. COBRA coverage will never last longer than 36 months, even if there s a second qualifying event. For example, if you and your spouse are in an 18-month COBRA period and you divorce, your spouse s COBRA period can be extended for up to 18 more months (up to a total of 36 months) but not beyond the 36-month total. You make all contributions for HCFSA COBRA coverage on an after-tax basis. For medical, dental, vision and/or EAP COBRA coverage: You pay 100% of the cost of coverage, plus a 2% administrative fee. If coverage is extended due to disability, you pay 150% of the cost of coverage for months The cost of coverage is paid on an after-tax basis. Provided you continue to make your required COBRA contributions on time, COBRA coverage will continue until: For HCFSA COBRA coverage The end of the calendar year in which your coverage ended. For medical, dental, vision and/or EAP COBRA coverage The earlier of: The end of the 18-, 29- or 36-month continuation period, as applicable. When one of the events shown in the When does COBRA coverage end? section occurs. See page 24. That s the summary. If you ever need COBRA, there s more you need to know. We ll start with a couple of definitions. 16 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

43 WHAT IS A QUALIFYING EVENT? A qualifying event leads to a loss of plan coverage. Qualifying events are listed below. For you You become a qualified beneficiary and are entitled to elect COBRA coverage if you lose coverage because: Your hours of employment are reduced; Your employment ends for any reason other than your gross misconduct; or Your employment ends because you fail to return to work from a family medical leave of absence (FMLA). For your dependent Your dependent becomes a qualified beneficiary and is entitled to elect COBRA if he or she loses medical, dental, vision or EAP coverage because: Your coverage ends due to: Your termination of employment (for reasons other than gross misconduct); A reduction in the number of hours you are employed, if there is a loss of coverage under the plan; or Your failure to return to active employment from FMLA; You enroll in Medicare (Part A, Part B or both); You and your spouse divorce or obtain a legal separation; Your domestic partner no longer qualifies as an eligible domestic partner; Your spouse, dependent child, stepchild or the child of your domestic partner no longer qualifies as an eligible dependent; or You die. For a domestic partner A domestic partner and/or a domestic partner s child must be enrolled in the medical, dental or vision plan or covered by the EAP at the time of their qualifying event. If they weren t enrolled or covered, they can t elect COBRA. In addition, domestic partners and their children are not allowed to elect HCFSA COBRA coverage. If you don t come back to work after a family medical leave of absence (FMLA) If you take an FMLA leave and don t return to work at the end of the leave, you and your dependents will be entitled to elect COBRA medical, dental and/or EAP coverage if: You and your dependents were covered under the plan on the day before the FMLA leave began (or became covered during the leave); and You and your dependents will lose plan coverage within 18 months due to your not returning to work. Contact the Benefits Center if this applies to you. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 17

44 OTHER INFORMATION WHO IS A QUALIFIED BENEFICIARY? For HCFSA COBRA, you are the qualified beneficiary. For COBRA medical, dental, vision and EAP coverage, qualified beneficiaries include: You and/or any covered dependents who were enrolled in the plan and lost coverage due to a qualifying event. Children born to, fostered by, adopted by, or placed for adoption by you or any qualified beneficiary during the COBRA continuation period. That child will be considered a qualified beneficiary as long as you are a qualified beneficiary and have elected COBRA continuation coverage for yourself. The child s COBRA coverage begins when he or she is enrolled in your coverage, and lasts for as long as COBRA lasts for your other family members. The child must satisfy the otherwise applicable requirements, such as age, to be an eligible dependent (see the dependent eligibility information in the separate Employee Medical, Employee Dental, Employee Vision, Employee Assistance Plan and/or Retiree Health booklets). Be sure to check with the COBRA Administrator before you add a new dependent just to make sure he or she is eligible. A child covered under a Qualified Medical Child Support Order (QMCSO). Your child who is receiving benefits under a QMCSO received during your period of employment with the company has the same COBRA rights as any of your other eligible dependent children. Domestic partners and their children, if they were covered under the applicable plan prior to a qualifying event. Note: Each qualified beneficiary can make his or her own independent COBRA medical, dental, vision and EAP election. 18 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

45 DISABILITY EXTENSION OF COBRA COVERAGE You and all of your qualified beneficiaries may be eligible to extend 18-month medical, dental, vision and/or EAP COBRA coverage for up to an additional 11 months (for a total of 29 months) if: The Social Security Administration (SSA) determines that you or your qualified beneficiary is disabled: At the time your work hours are reduced or you leave the company; or Within the first 60 days of COBRA coverage; and The disability continues throughout the COBRA continuation period. To be eligible for this 11-month extension: You or your qualified beneficiary must notify the COBRA Administrator of the disability within 65 days of the date the disability is determined, your work hours were reduced or you terminated employment with the company, whichever is later. This notification must be before the end of the original 18-month COBRA continuation period. If you miss either of these deadlines, COBRA coverage can t be extended. The extension of COBRA coverage applies to all of the qualified beneficiaries in your family, even those family members who aren t disabled, if the COBRA Administrator is notified by the above deadlines. WHAT IF THERE S A SECOND QUALIFYING EVENT? Your spouse, domestic partner, dependent children or domestic partner s dependent children can extend medical, dental and/or EAP COBRA coverage for up to a total of 36 months if one of the following qualifying events occurs during the initial 18- or 29-month COBRA coverage period, as applicable, following your termination of employment or reduction of hours: You and your spouse divorce or legally separate or your domestic partnership ends. Your dependent child no longer meets the eligibility requirements for benefit coverage. You die. These events will be considered a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the plan if the first qualifying event had not occurred. This extension is not available if the covered employee becomes enrolled in Medicare. The COBRA Administrator must be notified of the second qualifying event within 65 days of the later of the second qualifying event or the date the qualified beneficiary would lose coverage as a result of the second qualifying event (if it had occurred while the qualified beneficiary was still covered under the plan) in order for coverage to be extended. Your COBRA enrollment materials will include more information about disability extensions. If the qualified beneficiary is subsequently determined by the SSA to no longer be disabled, you must notify the COBRA Administrator. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 19

46 OTHER INFORMATION CAN I CHANGE MY COBRA COVERAGE? Well, maybe. It depends on the type of COBRA you re talking about. For COBRA medical, dental, vision and EAP coverage For HCFSA COBRA coverage You can cancel your coverage at any time. You can change your coverage elections each year during annual enrollment. If you have a change in status event, you may be able to make changes at other times. You can cancel your contributions at any time, but you cannot change your contribution amount. Unless you cancel coverage, your contributions will continue in the same amount through the end of the calendar year in which you terminate employment with the company. Changing your COBRA elections midyear This section applies to COBRA medical, dental and vision coverage only. Most of the time, you can t change your enrollment elections until the next annual enrollment period. However, if you have a change in status event as described in this section, you may be permitted or required to: Enroll in medical, dental and vision coverage; or Change the dependents covered under the plan. Your new coverage election must be consistent with the change in status event. There are a few very important deadlines: You have 90 days to ADD a newborn, a newly placed foster child, a newly adopted child or a child placed with you for adoption as a new dependent. If you miss this deadline, your new child will be covered for the first 31 calendar days only, and you ll have to wait until the next annual enrollment period to add him or her to your coverage. This applies even if you already have You + two or more coverage for your other dependents. You have 30 days to ADD a new dependent (OTHER THAN a newborn, a newly placed foster child, a newly adopted child or a child placed with you for adoption). If you miss this deadline, you ll have to wait until the next annual enrollment period. This applies even if you already have You + two or more coverage for your other dependents. You have 30 days to REMOVE a dependent who is no longer eligible. If you don t and the plan pays any medical or dental claims for this dependent, you will have to pay that money back. To make changes, contact the Benefits Center. 20 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

47 What qualifies as a change in status event? Here are the change in status events that allow, or require, you to make changes to your COBRA medical and dental elections. Your marriage, divorce, legal separation or annulment. An individual covered under a plan as your domestic partner no longer qualifies as your domestic partner (as that term is defined in the Glossary). The death of a dependent. The addition of a child through birth, foster placement, adoption or placement for adoption. A Qualified Medical Child Support Order that requires you to provide medical or dental coverage for a child (see page 10). A change in employment status by you or your dependent. A change in work schedule by you or your dependent that changes coverage eligibility. A change in your dependent s status. You and/or your eligible dependents become eligible or lose eligibility for Medicare. You and/or your dependents become entitled to COBRA. The taking of or return from a leave of absence under FMLA or USERRA. You or your dependents have a significant change in benefits or costs, such as benefits from another employer, etc. The Plan Administrator shall have the exclusive authority to determine if you are entitled to revoke an existing election as a result of a change in status event or a change in the cost or coverage, as applicable, and its determination shall bind all persons. If you have questions about change in status events, please contact the Benefits Center. What is HIPAA special enrollment? HIPAA special enrollment applies to COBRA medical coverage only. HIPAA special enrollment provides a few extra options when you have a change in status event. It applies to your dependents if: You didn t enroll a dependent in COBRA earlier because he or she had other medical coverage, and: That coverage is lost; or An employer stops contributing toward the cost of coverage. You gain a dependent due to marriage, birth, foster placement, adoption or placement for adoption. You or your dependent becomes eligible for premium assistance under Medicaid or the Children s Health Insurance Program (CHIP). Note that you have 60 days instead of 30 days to change your coverage. Special enrollment doesn t always apply. For example, it wouldn t apply if your dependent lost his or her other coverage for non-payment of premiums. Please contact the Benefits Center if you think special enrollment applies to you. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 21

48 OTHER INFORMATION ENROLLED IN THE PLAN S COBRA COVERAGE AND IN ANOTHER COMPANY S PLAN OR MEDICARE This section applies to continued medical coverage under COBRA only. It doesn t apply to dental or vision coverage or the Flexible Spending Plan s Health Care Flexible Spending Account participation. You may enroll in both the COBRA continuation coverage under the Medical Plan and in group health coverage under another employer s plan. However: If you elect COBRA continuation coverage under the Medical Plan first and then become covered (enrolled) in the company s or another employer s group health plan (but only after any applicable pre-existing condition exclusions of that other plan have been exhausted or satisfied) or enroll in Medicare (Part A, Part B or both), the company will reserve the right to cancel your COBRA continuation coverage. This rule does not apply if you are enrolled in the company s post-65 Medicare-eligible retiree medical options. In addition, you must notify the COBRA Administrator when the qualified beneficiary becomes covered under another group health plan or enrolls in Medicare Part A, Part B or both. The Plan Administrator may require repayment to the plan of all benefits paid after the coverage termination date, regardless of whether and when you provide notice to the COBRA Administrator of commencement of other group health plan coverage. If you elect coverage under another employer s group health plan first and then elect COBRA continuation coverage under the Medical Plan, you may have both coverages if you are willing to pay for both plans. If you elect to continue both COBRA under the Medical Plan and coverage under the other group health plan, then the other group health plan will be the primary plan for coordination of benefits. If you are enrolled in Medicare (Part A, Part B or both) prior to electing COBRA continuation coverage under the Medical Plan, Medicare coverage will be primary while you are enrolled in COBRA continuation coverage. In this case, when you complete the COBRA election process, you must indicate if any qualified beneficiary is enrolled in Medicare (Part A, Part B or both) and, if so, the date of the Medicare enrollment. If you are enrolled in Medicare (Part A, Part B or both) due to turning age 65 prior to or during COBRA continuation coverage under the Medical Plan, you can delay your enrollment in the post-65 Medicare-eligible retiree medical options until the end of COBRA continuation coverage. 22 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

49 HOW DO I PAY FOR COBRA COVERAGE? You will contribute the same amount for HCFSA coverage that you were contributing to the plan before your coverage ended. Unless you cancel your HCFSA coverage, your contributions continue for the remainder of that calendar year. The amount you pay for COBRA medical, dental, vision and EAP coverage is shown below: For 18-month or 36-month COBRA coverage Disability extension from 18 to 29 months Your cost is 102% of the full cost of coverage that is both the employee/retiree and employer costs to provide the benefit, plus a 2% administrative fee 150% of the full cost of coverage during months 19 through 29 (the extension period) The amount due for each month will be provided in your COBRA election notice. Your cost for medical, dental, vision and/or EAP coverage may change from time to time during your period of COBRA continuation coverage. Your payments must be sent to the COBRA Administrator. First payment You must make your first payment within 45 days after the date of your election. This payment must cover the cost of coverage from the date you lost coverage up to the time you make your payment, even if you had no claims during that time. Remaining monthly payments The payment for each month s coverage is due on the first day of the month. You ll be given a grace period of 30 days to make monthly payments. If you make a monthly payment later than its due date but within the 30-day grace period, your coverage under the plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the monthly payment is received. If you don t make payments as required, you will lose all COBRA rights under the plan, and claims for expenses incurred after your coverage ends will not be paid by the plan. Checks that are returned unpaid by a bank for any reason will result in untimely payment and result in cancellation of coverage. Partial payments will not be accepted and will be treated as non-payment, which will result in cancellation of coverage. If you have any questions, please contact the COBRA Administrator. Example: Julie terminated her employment with Phillips 66 on August 1. She elected COBRA and made her first payment on October 1, which was within 45 days of her COBRA election. That payment was for three months August 1 through October 31. You may make monthly payments either by check or automatic deductions from your bank account. Your COBRA enrollment materials will contain detailed information about payment methods. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 23

50 OTHER INFORMATION WHEN DOES COBRA COVERAGE END? COBRA coverage for your HCFSA ends on the earlier of: December 31 of the calendar year in which the qualifying event took place. The date you fail to timely pay the full monthly COBRA contribution for HCFSA coverage. COBRA coverage for medical, dental, vision and EAP ends on the earliest of the following dates: The date the covered person first becomes covered under another group health plan (but only after any pre-existing condition exclusions of that other plan for a pre-existing condition of the qualified beneficiary have been exhausted or satisfied).* The date the covered person is first enrolled in Medicare benefits under Part A, Part B or both.* The date the company stops providing any group health plan or EAP coverage to any employee. The date the covered person fails to timely pay the full monthly COBRA contribution for coverage. If coverage was extended to 29 months due to disability, the date the disabled person is no longer disabled (as determined by the Social Security Administration). The date coverage is terminated for any reason the plan would terminate coverage for a non-cobra participant. The end of the applicable 18-, 29- or 36-month period. The date on which you submit a fraudulent claim. The COBRA Administrator must be notified when a qualified beneficiary becomes covered under another group health plan or becomes enrolled in Medicare. WHAT IF I HAVE QUESTIONS? Questions concerning your plan or your COBRA rights should be addressed to the COBRA Administrator or the Benefits Center. For more information about your rights under ERISA, including COBRA, HIPAA, and other laws affecting group health plans, contact the nearest regional or district office of the U.S. Department of Labor s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at (Addresses and phone numbers of regional and district EBSA offices are available through EBSA s website.) * This applies only to medical and dental COBRA coverage and only if the coverage under the other group health plan or Medicare entitlement begins after the date that COBRA continuation coverage is elected under this plan. Contact the COBRA Administrator for information. 24 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

51 USERRA continuation coverage This information applies only to Phillips 66 employee medical, dental, vision and EAP benefits and to the Phillips 66 Flexible Spending Plan s Health Care Flexible Spending Account (HCFSA) (collectively referred to as the plan in this section), to the extent you are enrolled in the benefits provided under the plan at the time this section becomes applicable to you. Under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), the company must offer you a temporary extension of health coverage under the plan for you and your covered dependents at group rates in certain instances where coverage would not otherwise be available under the plan. Note: Under USERRA, unlike COBRA, dependents do not have a separate election right. To the extent you are covered under the plan and are placed on military leave of absence (up to 12 months), you will automatically continue coverage at the same rates as active employees. No election is required. If you are covered under the plan and your military leave of absence ends with the company (your employment ends), but you are still serving in the uniformed services, you can elect military absence COBRA continuation coverage (USERRA continuation coverage) until the earlier of 24 months or the date you fail to apply for or return to employment as an employee of the company. HCFSA participation can continue only until the end of the calendar year of your employment end date. You (or your authorized representative) may elect to continue your coverage under the plan for yourself and your covered dependents by making an election with the COBRA Administrator and by paying the applicable cost for your coverage. The election must be made within 65 days of the later of the date of the COBRA Enrollment Notice or the date the coverage ends. If you fail to make an election or do not make your payment within the required timeframe, you will lose your USERRA continuation rights under the plan except in the case where your failure to give advance notice of service was excused under USERRA because it was impossible, unreasonable, or precluded by military necessity. In that case, the plan will reinstate your coverage retroactively upon your election to continue coverage and payment of all unpaid amounts due. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 25

52 OTHER INFORMATION Your USERRA continuation coverage cost is 102% of the full costs (including both employer and employee costs). Payments must be sent to the COBRA Administrator. You must make your first payment within 45 days after the date of your election. This payment must cover your costs up to the time you make your payment. Thereafter, the cost for each month s coverage is due on the first day of the month. You will be given a grace period of 30 days to make these subsequent monthly payments. However, if you make a monthly payment later than its due date but during its grace period, your coverage under the plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the monthly payment is received within the 30-day grace period. If you elect to continue coverage under USERRA, the USERRA continuation coverage may be continued for up to 24 months. However, coverage will end earlier, if one of the following events takes place: You fail to make a payment within the required time; You fail to return to work within the time required under USERRA following the completion of your service in the uniformed services; or You lose your rights under USERRA as a result of a dishonorable discharge or other undesirable conduct specified in USERRA. COBRA and USERRA continuation coverage are concurrent for the first 18 months. This means that both COBRA and USERRA continuation coverage begin when your military leave of absence with the company ends (your employment ends), and you are still serving in the uniformed services. However, COBRA coverage terminates at the end of 18 months and USERRA continuation coverage terminates at the end of 24 months, unless coverage is terminated earlier due to non-payment of costs or another permitted event described earlier. You must apply for employment or return to employment within the period required under USERRA for benefit reinstatement. If you cancelled your plan coverage while on military leave of absence, it will be reinstated after you return to work. If you return to work from a military leave of absence during the same calendar year, you will be re-enrolled automatically in the same coverage options that you had before the leave began. If you return to work from a military leave of absence in a different year, you can change your options. HIPAA privacy rules This information applies only to Phillips 66 medical, dental, vision and EAP benefits and to the Phillips 66 Flexible Spending Plan s Health Care Flexible Spending Account (HCFSA) (collectively referred to as the plan in this section). USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION The plan will use protected health information (PHI) to the extent of and in accordance with the uses and disclosures permitted by the privacy standards under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the plan will use and disclose PHI for purposes related to health care treatment, payment for health care and health care operations. PHI is information that may identify you and that relates to (a) your past, present, or future physical or mental health or condition or (b) the past, present or future payment for your health care. 26 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

53 Payment includes activities undertaken by the plan to obtain premiums or determine or fulfill its responsibility for coverage and provision of plan benefits that relate to an individual to whom health care is provided. These activities may include, but are not limited to, the following: Determination of eligibility, coverage and costsharing amounts (for example, cost of a benefit, plan maximums and copays determined for an individual s claim); Coordination of benefits; Adjudication of health benefit claims (including appeals under the claims and appeals procedures and other payment disputes); Subrogation of health benefit claims; Establishing employee and retiree contributions; Risk-adjusting amounts due based on enrollee health status (looked at in aggregate and not individually) and demographic characteristics; Billing, collection activities and related health care data processing; Claims management and related health care data processing, including auditing payments, investigating and resolving payment disputes and responding to participant inquiries about payments; Obtaining payment under a contract for reinsurance (including stop-loss and excess of loss insurance); Medical necessity reviews or reviews of appropriateness of care or justification of charges; Utilization review, including pre-certification, pre-authorization, concurrent review and retrospective review; Disclosure to consumer reporting agencies related to the collection of premiums or reimbursement (the following PHI may be disclosed for payment purposes: name and address, date of birth, Social Security number, payment history, account number and name and address of provider and/or health plan); and Reimbursement to the plan. Health care operations may include, but are not limited to, the following activities: Quality assessment; Population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, disease management, contacting health care providers and patients with information about treatment alternatives and related functions; Rating provider and plan performance, including accreditation, certification, licensing or credentialing activities; Underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing or placing a contract for reinsurance of risk relating to health care claims (including stop-loss insurance and excess of loss insurance); Conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse detection and compliance programs; Business planning and development, such as conducting cost-management and planningrelated analyses related to managing and operating the plan, including formulary development and administration, development or improvement of payment methods or coverage policies; OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 27

54 OTHER INFORMATION Business management and general administrative activities of the plan, including, but not limited to: Management activities relating to the implementation of and compliance with HIPAA s administrative simplification requirements, also known as privacy requirements; or Customer service, including the provision of data analyses for the Plan Sponsors, policyholders or other customers; Resolution of internal grievances; and Due diligence in connection with the sale or transfer of assets to a potential successor in interest. The plan will use and disclose PHI as required by law and as permitted by authorization of the participant or beneficiary With an authorization by the participant or beneficiary (that is, you or your covered dependent), the plan will disclose PHI to whatever entity is set forth in the authorization, including a customer service representative, disability plans, reciprocal benefit plans and Workers Compensation insurers for purposes related to administration of those plans and programs. A plan representative will be able to assist participants and beneficiaries with an aspect of a claim he or she may have under the plan only if the participant or beneficiary provides the representative with written permission. The plan representative will request that you complete and sign an Authorization for Release of Information. In the authorization, you will give the representative permission to interface with the plan and thirdparty administrator on your behalf. The plan representative will not handle disputes with providers; therefore, authorization forms will not be accepted except under rare and limited circumstances. For purposes of this section, Phillips 66 Company is the Plan Sponsor The plan will disclose PHI to the Plan Sponsor only upon receipt of a certification from the Plan Sponsor that the plan document has been amended to incorporate the following provisions, of which the Plan Sponsor has provided such certification. With respect to PHI, the Plan Sponsor agrees to certain conditions The Plan Sponsor agrees to: Not use or further disclose PHI other than as permitted or required by the plan document or as required by law; Not use genetic information for underwriting purposes in compliance with the Genetic Information Nondiscrimination Act of 2008 (GINA); Ensure that any agents, including a subcontractor, to whom the Plan Sponsor provides PHI received from the plan, agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to such PHI; Not use or disclose PHI for employment-related actions and decisions unless authorized by a participant or beneficiary or a personal representative of the participant or beneficiary; Not use or disclose PHI in connection with any other benefit or employee benefit plan of the Plan Sponsor unless authorized by the participant, beneficiary or his or her respective personal representative, unless such plan is part of the organized health care arrangement of which the plan is a part, as described below; Report to the plan any PHI use or disclosure of which it becomes aware, if such use or disclosure is inconsistent with the permitted uses or disclosures; Make PHI available to a participant, beneficiary or his or her personal representative in accordance with HIPAA s access requirements; 28 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

55 Make PHI available for amendment and incorporate any amendments to PHI in accordance with HIPAA; Make available the information required to provide an accounting of disclosures; Make internal practices, books and records relating to the use and disclosure of PHI received from the plan available to the HHS Secretary for purposes of determining the plan s compliance with HIPAA; If feasible, return or destroy all PHI received from the plan that the Plan Sponsor still maintains in any form and retain no copies of such PHI when no longer needed for the purpose for which disclosure was made (or if return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction infeasible); and Notify individuals or the HHS Secretary, as necessary, of a breach of unprotected PHI within 60 days of discovery in accordance with HIPAA. Notices will contain a description of the breach (what happened, date of the breach and date of discovery; a list of the types of information involved; suggested steps for the individual s protection; a description of the investigation, mitigation and protection for the future; and contact procedures to obtain more information). Adequate separation between the plan and the Plan Sponsor must be maintained In accordance with and to the extent permitted under HIPAA, only the following employees or classes of employees may be given access to PHI: HR Shared Services Staff designated by the Manager, Benefits, HR Shared Services. Manager, Compensation. Manager, Compensation administrative assistant. Manager, HR Shared Services. Manager, HR Shared Services administrative assistant. Mail & Document Services Staff of Corporate Information Services. Documents & Records Management Staff of Corporate Information Services. Manager, Health Services. Manager, Health Services administrative assistant. Employee Benefits Counsel. Employee Benefits Counsel legal and administrative assistant(s). For the Employee Assistance Plan: Plan Administrator. Staff designated by the Plan Administrator. Manager, Health Services. Employee Benefits Counsel. Employee Benefits Counsel legal and administrative assistant(s). For medical and dental coverage and the Flexible Spending Plan HCFSA: Vice President, Human Resources. Manager, Benefits. Health & Welfare Staff designated by the Manager, Benefits. Manager, Benefits, HR Shared Services. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 29

56 OTHER INFORMATION Limitations of PHI access and disclosure The persons described in the previous section may have access to, and use and disclose, PHI for plan administration functions that the Plan Sponsor performs for the plan only to the extent permitted under HIPAA. If the persons named above do not comply with the rules for use and disclosure of PHI, the Plan Sponsor shall provide a mechanism for resolving issues of noncompliance, including disciplinary action up to and including termination of employment. Organized health care association The Phillips 66 Medical and Dental Assistance Plan, the Phillips 66 Flexible Spending Plan and the Phillips 66 Employee Assistance Plan have been designated as part of an organized health care association in order to share certain PHI related to treatment, payment and health care operations under the respective plans, lifetime maximums, deductibles and disenrollment from one plan and enrollment to another plan due to open enrollment, relocation or similar circumstances. HIPAA security requirements applicable to electronic PHI The Plan Sponsor will: Implement safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of electronic PHI that it creates, receives, maintains or transmits on behalf of the plan; Ensure that the adequate separation between the plan and Plan Sponsor, with respect to electronic PHI, is supported by reasonable and appropriate security measures; Ensure that any agent, including a subcontractor, to whom it provides electronic PHI agrees to implement the provisions of HIPAA and the Health Information Technology for Economic and Clinical Health Act (HITECH); and Report to the plan any security incident of which it becomes aware concerning electronic PHI. For more information regarding HIPAA Privacy and the plan, please contact HR Connections or see hr.phillips66.com. Genetic Information Nondiscrimination Act The medical and dental plans don t collect or use genetic information, including family medical history, to determine eligibility for enrollment or for underwriting purposes. These plans don t require genetic testing and won t use genetic information to determine premium or contribution amounts. 30 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

57 An authorized representative is Claims and appeals procedures Note: Except for appeals related to eligibility to participate in the plan, the information in this section doesn t apply to any of the HMO or CIGNA Group Health Benefit options. It also doesn t apply to the post-65 Medicare-eligible retiree medical options. Those plans have their own procedures, which are explained in separate booklets provided for each plan. Each of the separate health and welfare plan booklets (Employee Medical, Employee Dental, Employee Vision, Flexible Spending Plan, Employee Assistance Plan and Retiree Health) describe what you need to do in order to file a claim for benefits under that plan. A person authorized to file claims or appeals on your behalf. For this person to be considered your authorized representative, one of the following requirements must be satisfied: You have given express written consent for the person to represent your interests. The person is authorized by law to give consent for you (e.g., parent of a minor, legal guardian, foster parent, power of attorney). For pre-service and urgent care claims, the person may be: Your immediate family member (e.g., spouse, parent, child, sibling); Your primary caregiver; or Your health care professional who knows your medical condition (e.g., your treating physician). For outpatient concurrent care claims, the person may be: Your immediate family member (e.g., spouse, parent, child, sibling); or Your primary caregiver. For inpatient concurrent care claims, the person may be a health care professional who knows your medical condition (e.g., your treating physician). For the Flexible Spending Plan ( FSP ), this Claims and appeals procedures section applies only to the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account. In this section, we ll explain what to do if a claim is denied. Although we say you throughout this section, we mean you or anyone else duly authorized to work on your behalf. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 31

58 OTHER INFORMATION MAKING A DECISION ON YOUR CLAIM In general, the Claims Administrator must notify you of its decision regarding your claim within the timeframe shown below. Deadlines for decisions on benefit claims Medical, dental, vision, FSP and EAP claims There are three different types of claims, depending on the urgency and timing of the health care service involved. The rules for claims and appeals vary depending on the type of claim involved. Urgent care claims and pre-service claims (Apply to the Employee Medical Plan, Employee Dental Plan, Employee Assistance Plan and Retiree Medical Plan) Post-service claims (Apply to the Employee Medical Plan, Employee Dental Plan, Employee Vision Plan, Flexible Spending Plan and Retiree Medical Plan) An urgent care claim is a pre-service claim where delaying a decision on the claim until the usual deadline: Could seriously jeopardize your life or health or your ability to regain maximum function; or Would, in the opinion of a physician who knows your medical condition, subject you to severe and unmanageable pain. The plan will treat a claim as an urgent care claim if the physician or dentist treating you advises the plan that the claim satisfies the urgent care criteria. Whether a claim meets the urgent care criteria is determined at the time the claim is being considered. A pre-service claim is a claim for a benefit that is required to be preapproved before the service is received in order to get the maximum plan benefit. This includes such things as required pre-certification, case management or utilization review, and requests to extend a course of treatment that was previously preapproved. A post-service claim is a claim for a benefit that is not required to be preapproved before the service is received in order to get the maximum plan benefit. Most claims under the Employee Medical Plan, Retiree Medical Plan and Employee Dental Plan and all claims under the Employee Vision Plan and Flexible Spending Plan will be post-service claims. 32 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

59 In general, the Claims Administrator must notify you of its decision on your claim within the following timeframes: For this type of claim: Urgent care claims Pre-service claims Post-service claims Initial determination will be made: As soon as possible after the claim is received, but not longer than 72 hours. (See the following paragraph for extension rules.) Within a reasonable time after the claim is received, but not longer than 15 days. (See the second following paragraph for extension rules.) Within a reasonable time after the claim is received, but not longer than 30 days. (See the second following paragraph for extension rules.) The deadline for a decision on an urgent care claim may be extended if you do not provide the Claims Administrator with all the necessary information to make a decision on your claim. The Claims Administrator will notify you of the specific information needed to complete your claim within 24 hours after receiving the claim. You will have a reasonable period of time (not less than 48 hours) to provide the information. The Claims Administrator will notify you of its decision as soon as possible, but not later than 48 hours after it receives the requested information (or 48 hours after the deadline for you to provide the information, if earlier). The deadline for a decision on a pre-service claim or post-service claim may be extended for up to 15 days, if special circumstances beyond the control of the plan exist. If the Claims Administrator needs to extend the deadline, you will be notified in writing before the initial determination deadline. The notice will tell you why the extension is necessary and when the Claims Administrator expects to make the decision on your claim. If an extension is necessary because you did not provide all the information necessary to make a decision on your claim, the notice will specifically describe the required information, and you will have at least 45 days after you receive the notice to provide that information. The deadline for a decision will be extended by the length of time that passes between the date you are notified that more information is needed and the date that the Claims Administrator received your response to the request for more information. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 33

60 OTHER INFORMATION Extensions and terminations of preapproved benefits If an ongoing course of treatment has been preapproved as an urgent care claim or other pre-service claim, some special deadlines apply if: You need to obtain an extension of the approved benefit; or The plan determines that the benefit should no longer be continued or should be for a shorter course of treatment than earlier expected. If you make an urgent care claim that is a request to extend a previously approved course of treatment, the Claims Administrator must notify you of its decision within 24 hours after the request is received. This rule applies only if you request the extension at least 24 hours before the end of the previously approved course of treatment. Otherwise the request will be treated like any other new urgent care or other pre-service claim. For medical and EAP claims, you may also proceed with an expedited external review that takes place at the same time as your appeal. Please see Expedited external review on page 45 for more information. If the Claims Administrator determines that payments for a previously approved course of treatment should be stopped before the scheduled end of that approved treatment, the Claims Administrator must give you a notice (which will be treated as a claim denial) and give you adequate time to appeal. You will receive a determination on the appeal before the plan stops paying benefits for that treatment. While the appeals process must be followed, the Claims Administrator may give you only a reasonable period of time to appeal the denial, rather than the standard 180 days. Special rules for medical, dental and EAP urgent care and pre-service claims Improperly filed claims If you try to file an urgent care claim or other pre-service claim and you do not file the claim as required by these claims procedures, the Claims Administrator will notify you that you did not file the claim properly and tell you how you can file the claim properly. You may be notified orally, in which case you may request a written notice. You will only be notified if: You made the improper claim to someone at Phillips 66 who customarily handles benefit matters, to the Claims Administrator, or to a case management or utilization review or similar company that provides services to the plan; and Your improper claim included your name, the specific medical condition or symptom, and the specific proposed treatment, service or product that you are trying to get approved. If you meet these requirements, you ll be notified that you did not file your claim properly as soon as possible, but not later than 24 hours after the improperly filed urgent care claim is received, or five days after any other improperly filed pre-service claim is received. Incomplete urgent care claims If you file an urgent care claim properly but do not provide the Claims Administrator with all the necessary information to make a decision on your claim, the Claims Administrator will notify you of the specific information needed to complete your claim within 24 hours after receiving the claim. You will have a reasonable period of time (not less than 48 hours) to provide the information. The Claims Administrator will notify you of its decision as soon as possible, but not later than 48 hours after it receives the requested information (or 48 hours after the deadline for you to provide the information, if earlier). 34 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

61 Written approval notices In general, the plan is not required to give you a written notice if a claim is approved. However, the plan must give you a written or electronic notice by the deadlines indicated in this section if an urgent care or other pre-service claim is approved. Denials of claims If your denied claim was a medical or EAP urgent care claim, the notice may be given to you orally first, followed by written or electronic notice within three days. If all or part of your claim is denied, you will be given a written or electronic notice that will include: The specific reason(s) for the denial, including information to identify the claim involved with a description of the plan s standard used for denying the claim, if applicable; The date of service, the health care provider, the claim amount (if applicable), and the availability of the diagnosis and treatment codes (if applicable) with corresponding meanings of such codes (upon request); References to each of the specific provision(s) of the plan on which the denial is based; A description of any additional material or information you must provide in order for your claim to be approved, and an explanation of why that material or information is necessary; If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to you free of charge upon request; If the claim denial was based on medical necessity, experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment for applying the exclusion or limit to your circumstances, or a statement that such an explanation will be provided to you free of charge upon request (not applicable to the Vision Plan); A statement that you are entitled, upon request, to see all documents, records and other information relevant to your claim for benefits, and also that you are entitled to get free copies of that information; An explanation of the appeals procedures, and, if applicable, any voluntary external review including time limits that apply; A statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman; The availability of the claim denial in another language, as necessary; A statement of your right to file a lawsuit in federal court under ERISA section 502(a), if your claim is denied on final appeal; and If your denied claim was a medical or EAP urgent care claim, a description of the expedited appeals procedure that applies to urgent care claims. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 35

62 OTHER INFORMATION HOW TO FILE AN APPEAL Appeals must be filed within very specific timeframes. If you miss the deadlines shown here, you CANNOT appeal. The deadlines are: 180 days for the first level of appeal. 90 days for the second level of appeal (the 90 days start after your first appeal denial is received) except for the Vision Plan. 60 days for the second level of appeal for the Vision Plan. If all or part of your claim is denied, you can appeal that denial. The goal of the appeals process is to ensure you have a full and fair review of your appeal. Pending the outcome of a medical or EAP concurrent care claim or urgent care claim appeal, your benefits for an ongoing course of treatment will not be reduced or terminated pending the outcome of the appeal. It is possible that you may also elect to have an expedited appeals process or an expedited external review. Depending on the type of claim, you may have up to two levels of appeal, plus an external review. Special rule for urgent care appeals There is only one level of review on appeal. Medical, dental or EAP urgent care appeals don t have to be in writing; you can make urgent care appeals orally. In addition, all communications between you and the plan for an urgent care appeal can be conducted by telephone, facsimile or other available expedited method of communication. For medical and EAP urgent care claim appeals, you can request an expedited external review to run concurrently with the appeals process. For more information about external reviews, see page PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

63 Except for urgent care claim appeals, your appeal must be made in writing and sent to the appropriate Appeals Administrator as shown below. Start with the first level Appeals Administrator when your claim is first denied. Type of benefit Appeals Administrator first level appeals Medical, prescription drug and mental health/substance abuse benefits Eligibility to participate in the plan All employee and retiree medical plan options Eligibility for a disabled child to participate in the plan Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan Medical benefits Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan Wellness Incentive Credit Non-Medicare participants in the Consumer Plan or PPO Plan Outpatient prescription drugs Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan Mental health and substance abuse Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) Aetna, Inc. or Blue Cross Blue Shield of Texas at the address shown below Medical Claims Administrator Aetna, Inc. National Account CRT P.O. Box Lexington, KY (855) Medical Claims Administrator Blue Cross Blue Shield of Texas P.O. Box Dallas, TX (855) N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) Rx Claims Administrator Medco Health Solutions 8111 Royal Ridge Parkway Irving, TX (877) Phillips 66 Appeals c/o ValueOptions P.O. Box 1347 Latham, NY (866) Appeals Administrator second level appeals Phillips 66 Plan Administrator Manager HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 37

64 OTHER INFORMATION Type of benefit Dental benefits Eligibility to participate in the plan Employee Dental Eligibility for a disabled child to participate in the plan Employee Dental Dental benefits Employee Dental Vision benefits Eligibility to participate in the plan Employee Vision Vision benefits Employee Vision Appeals Administrator first level appeals N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) MetLife, at the address shown below MetLife Dental Claims P.O. Box El Paso, TX (855) N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) Vision Service Plan Attn: Appeals Dept. P.O. Box 2350 Rancho Cordova, CA (800) Employee Assistance Plan (EAP) benefits Eligibility to participate in the plan EAP Flexible Spending Plan benefits Eligibility to participate in the plan Health Care Flexible Spending Account (HCFSA) or Dependent Care Flexible Spending Account (DCFSA) claims for benefits N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) ValueOptions, Inc. Phillips 66 Claims P.O. Box 1347 Latham, NY (866) N/A (only one level of appeal is provided, and it s with the Appeals Administrator shown at right) WageWorks Claims Appeals Board P.O. Box 991 Mequon, WI Or fax to: (877) Appeals Administrator second level appeals Phillips 66 Plan Administrator Manager HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) Phillips 66 Plan Administrator Manager HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) Vision Service Plan Attn: Appeals Dept. P.O. Box 2350 Rancho Cordova, CA (800) Phillips 66 Plan Administrator Manager, HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) Phillips 66 Plan Administrator Manager, HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

65 Please indicate in large letters at the top of your letter that your letter is an appeal. In your appeal, you may: Include written comments, documents, records and other information relating to your claim, whether or not those materials were submitted with your initial claim. Request to see and get free copies of all documents, records and other information relevant to your claim. By filing an appeal, you are consenting to the release of relevant health information for claims processing purposes. You or the covered dependent may also be required to have an exam, or have an autopsy performed in the event of death. You may also have to sign an authorization for release of relevant medical or dental records. No personnel decisions may be made against you based on the outcomes of this review and appeals process. Review of denied claim on appeal The appropriate Appeals Administrator will reconsider any denied claim that you appeal by the deadline. The appropriate Appeals Administrator must consider all information provided by you, even if this information was not submitted or considered in the original claim decision. For medical, dental, vision, FSP, EAP and disability appeals, the review will not defer to the original claim denial and will not be made by the person who made the original claim denial or a subordinate of that person. Prior to issuing a denial of an appeal, the Appeals Administrator will provide you, free of charge, any new or additional evidence or rationale considered, relied upon or generated in connection with the claim. If you choose to respond or rebut this new evidence, you must do so prior to the deadline for the final determination. If the claim denial is based on a medical judgment, the Appeals Administrator must get advice from a health care professional who has training and experience in the area of medicine. This professional cannot be a person who was consulted in connection with the original claim decision (or a subordinate of the person who was consulted in the original claim). Upon request, you will be provided with the names of any medical or vocational experts who were consulted in connection with your claim denial, even if the advice was not relied upon in making the denial. Denials of appeals If all or part of your claim is denied on appeal, you will be given a written or electronic notice that will include: The specific reason(s) for the denial; References to the specific provision(s) of the plan on which the denial is based; For medical and EAP claims only, if any internal rule, guideline or protocol was used in denying the claim on appeal, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim on appeal and that a copy will be provided to you free of charge upon request; If the medical, dental, FSP, EAP or disability claim denial on appeal was based on medical necessity, experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment for applying the exclusion or limit, as applied to your circumstances, or a statement that such an explanation will be provided to you free of charge upon request; OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 39

66 OTHER INFORMATION A statement that you are entitled, upon request, to see all documents, records and other information relevant to your claim for benefits, and also that you are entitled to get free copies of that information; A statement describing any further appeal procedures and, if applicable, any voluntary external review offered by the plan, including any applicable deadlines, and your right to obtain further information about such procedures; For medical and EAP claims, a statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman; The availability of the claim denial in another language, as necessary; and A statement of your right to file a lawsuit in federal court under ERISA section 502(a) (for medical, dental and EAP claims that qualify for a second level of appeal, the statement would apply only if your claim is denied on final appeal). The following statement: You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your state insurance regulatory agency. Second level appeal to Appeals Administrator This section doesn t apply to urgent care claims or claims relating to eligibility to participate in the plan (other than to appeals of a disabled child s eligibility to participate). If the first level Appeals Administrator denies your claim on appeal, you can make a second, and final, appeal to the second level Appeals Administrator. All the rules for the first level appeal will apply to your final appeal, except for the following changes in deadlines: You ll have a reasonable period of time, not to exceed 90 days, to make your final appeal after you receive the first appeal denial. This is 60 days for the Vision Plan. All appeal deadlines that were measured from the date of your first appeal, will now be measured from the date your second appeal is filed with the Appeals Administrator. In a final appeal, the health care professional reviewing the appeal will be different than the health care professional who reviewed the first level appeal. 40 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

67 Deadlines for decisions on appeals The appropriate Appeals Administrator must make its decision on your appeal within the following timeframes: For this type of appeal Pre-service appeal Post-service appeal (does not apply to the EAP) The timeframe for a final determination is Within 15 days Within 30 days Sometimes, the Appeals Administrator may need additional time or information to decide the claim. If this happens, it will let you know in writing. It will also tell you why the extension is needed. If the extension is needed because you didn t provide all the information necessary to make a decision on your appeal: The notice will specifically describe the required information; You ll be given a reasonable period of time to provide that information; and The time to respond to your appeal will be tolled until you provide the requested information. The Appeals Administrator s decision is final The Appeals Administrator that makes the final appeals decision acts as fiduciary under ERISA and has the full discretion and authority to: Make final determinations of all questions relating to eligibility for any plan benefit and to interpret the plan for that purpose; and Make final and binding grants or denials of benefits under the plan. Benefits under the plan only will be paid if the appropriate Appeals Administrator decides in its sole discretion that the applicant is entitled to benefits. The determination of the appropriate Appeals Administrator on appeal will be final and binding. You must exhaust all administrative remedies under the plan. If you ve gone through the appeals process and still believe you re entitled to a plan benefit, you may file a civil action under section 502(a) of ERISA to recover benefits due under the terms of the plan, to enforce your rights under the terms of the plan, or to clarify your rights to future benefits under the terms of the plan. Any civil action must be filed within three years from the date of the Appeals Administrator s final decision on appeal. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 41

68 OTHER INFORMATION External review External reviews apply to medical and EAP claims only. Availability of external review If, after exhausting the two levels of appeal,* you are not satisfied with the final determination and your claim involves medical judgment, as determined by the independent review organization (IRO), or rescission of coverage, you may choose to participate in the voluntary external review process. You must request the external review within four months after being notified of the denied appeal. If there is not a corresponding date that is four months after receipt of the denied appeal, the external review request must be filed by the first day of the fifth month following receipt of the notice. For example: You receive your final appeal denial from the plan on October 30. The deadline in this situation would be March 1 because February 30 (the actual four-month deadline) does not exist. For urgent care claim appeals and concurrent care claim appeals, you can request the external review to run concurrently with the appeals process. Preliminary review Within five days of receiving the request for external review, the Plan Administrator will conduct a preliminary review. The Plan Administrator will review whether: You are eligible for external review; The denied claim or appeal does not relate to plan eligibility; You or your eligible dependent are covered under the health plan; You or your eligible dependent were provided all information required to process the claim; and You or your eligible dependent have completed all internal plan appeal processes. * You have the right to request an external review prior to the exhaustion of the full appeal process available if the plan does not follow Department of Labor proscribed guidelines. Within one day of completing the preliminary review, the Plan Administrator will notify you in writing whether your request for the external review is approved or denied. If your request is complete but not eligible for external review, the notice will state the reasons for your ineligibility. If your request is denied, the Plan Administrator will include reasons for the denial, including if and why your request was incomplete and a deadline for supplying the information to make the request complete. 42 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

69 Independent Review Organization If your external review request is approved, the Plan Administrator will assign your request to an IRO. The IRO will then provide you with a notice regarding whether your external review request is eligible for review and whether it is accepted. The notice will also inform you that the IRO will accept additional information in writing within 10 business days following receipt of the notice, and will consider relevant additional information in its external review. The Plan Administrator will provide the IRO all the documents and information considered in denying the claim. If the Plan Administrator does not provide this information to the IRO within five business days, the IRO may stop its review and reverse the Plan Administrator s decision. The IRO will notify you and the Plan Administrator within one business day if there is a decision to reverse. If you provide additional information to the IRO within 10 business days following your receipt of the IRO s initial notice, the IRO is required to share this information with the Plan Administrator within one business day. The Plan Administrator, in light of this new information, may choose to reconsider or reverse the denial, which will stop the external review process. If the Plan Administrator reverses the denial, it will provide written notice to you and the IRO within one business day. If the Plan Administrator does not reverse the denial, the IRO will review all the documents and information it receives without giving any weight to the plan s earlier conclusions or decisions. The IRO must complete its review and send notice to both you and the Plan Administrator within 45 days. The IRO s notice will include the following information: A general description of the reason for the external review request, including information sufficient to identify the claim. This includes the date(s) of service, the provider, claim amount (if applicable), diagnosis and treatment codes (and their corresponding meanings) and the reason for the prior denial; The date the IRO received the assignment to conduct the external review, and the date of the IRO s decision; References to the evidence or documentation considered in reaching the decision, including specific coverage provisions and evidence-based standards; A discussion of the principal reason(s) for the IRO s decision, including the rationale for its decision and any evidence-based standards relied on in making the decision; A statement that the IRO s determination is binding unless other remedies are available to you (or the plan) under state or federal law; and A statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman. Final decision The decision made by the IRO is the final decision. If the IRO s decision reverses the plan s decision, the plan must immediately provide coverage or payment for the claim. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 43

70 OTHER INFORMATION Summary of timeline Step in external review process Request for external review after exhausting appeals process* must be made within: The Plan Administrator must review your request in: The Plan Administrator must notify you of the preliminary review decision within: The Plan Administrator must provide all information to the IRO within: You can provide additional information to the IRO within: The IRO forwards any additional information submitted by you to the Plan Administrator within: If the Plan Administrator reverses its denial and provides coverage, notice must be sent to you and the IRO within: The IRO must notify you and the Plan Administrator of its decision within: Timeframe Four months after receipt of benefits denial notice Five business days following receipt of external review request One business day after completion of preliminary review Five business days of assignment of IRO Ten business days following receipt of notice from IRO One business day of receipt One business day of decision 45 days after receipt of request for review * For an urgent care claim or concurrent care claim or if the plan has not followed Department of Labor proscribed guidelines, you may request an external review prior to completion of the full appeals process. 44 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

71 Expedited external review You can request an expedited external review if: Your claim denial involves a medical condition that would cause serious jeopardy to your life or health or your ability to regain maximum function if you were forced to abide by the timeframe of the appeals process; or Your claim denial involves admission, availability of care, continued stay or an emergency health care item or service and you have not been discharged from the medical facility. The preliminary review will take place immediately upon receiving the external review request. The Plan Administrator will send you a notice whether your request is approved or denied. Once your request is accepted, the Plan Administrator will send all necessary documents and information considered in making the benefits denial to the assigned IRO. The documents and information will be provided electronically, by telephone, fax or any other expeditious method available. The IRO will consider the documents and information received to the extent the information or documents are available and the IRO considers them appropriate. The IRO will provide notice of its final external review decision as expeditiously as your medical condition or circumstances require but not more than 72 hours after the IRO receives the expedited external review request. If the final external review decision is not in writing, the IRO must provide written confirmation of the decision to you and the Plan Administrator within 48 hours after the date the IRO provided the non-written notice of final external review decision. FRAUDULENT CLAIMS If the plan finds that you or someone on your behalf has submitted a fraudulent claim to the plan, the plan has the right to recover any amounts paid by the plan with respect to fraudulent claims or expenses and may take legal action against you. Upon determining that a fraudulent claim has been submitted, the plan has the right to permanently terminate the coverage provided for you and your dependents under the plan, and the Plan Administrator has the authority to take any actions it deems appropriate to remedy such violations, including pursuing legal action or equitable remedies to recover any payments made by the plan to any party, regardless of when the fraudulent claim was discovered. Such action will not preclude the company from taking other appropriate action. If medical, dental or EAP coverage is terminated retroactively, you will be given a written 30-calendar day notice prior to the retroactive termination of coverage. You will have the right to appeal the decision by going through the appeals process that applies to the specific benefit being terminated. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 45

72 OTHER INFORMATION ERISA plan information The plans listed below are governed by a federal law, ERISA, and are subject to its provisions. Phillips 66 Medical and Dental Assistance Plan* (Commonly referred to as the Employee Medical Plan, the Retiree Medical Plan, the Employee Dental Plan and the Employee Vision Plan) Plan name Type of plan Plan number 501 Plan year and fiscal records Plan funding and sources of contributions Plan Medical Director Phillips 66 Medical and Dental Assistance Plan Medical and hospital care welfare plan. Also includes retail prescription drugs, home delivery prescription drugs, dental and vision coverage. January 1 December 31 The Employee Medical Plan (Consumer Plan, PPO Plan), the Retiree Medical Plan (Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan) and Dental Plan options under the plan are self-insured by Phillips 66 Company. Any participant contributions are separately accounted for from Phillips 66 Company s general assets. All expenses and charges are paid from participant contributions and Phillips 66 Company s general assets. No benefits under the plan are guaranteed by any insurance policy or contract, unless you are enrolled in an HMO, the post-65 Medicare-eligible retiree medical options, the Vision Plan or in CIGNA Group Health Benefits. Benefits for those plans are provided pursuant to insurance contracts. General Manager and Chief Medical Officer for Phillips 66 Company Group numbers Aetna Medical: Blue Cross Blue Shield of Texas: , Medco Health Solutions, Inc. (Express Scripts): PHIL66RX MetLife Dental: VSP Vision: (continued) * Eligible store employees are designated as participating in a separate plan from eligible non-store employees for the purpose of Section 105(h) of the Internal Revenue Code and all other nondiscrimination requirements. 46 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

73 Phillips 66 Employee Assistance Plan (Commonly referred to as the Employee Assistance Plan or the EAP) Plan name Type of plan Plan number 506 Plan year and fiscal records Plan funding and sources of contributions Plan Medical Director Phillips 66 Employee Assistance Plan Employee assistance welfare benefit plan. January 1 December 31 Benefits under the plan are provided at no cost to employees. General Manager and Chief Medical Officer of Phillips 66 Company Phillips 66 Flexible Spending Plan* (Commonly referred to as the Flexible Spending Plan or FSP) Plan name Type of plan Plan number 504 Plan year and fiscal records Phillips 66 Flexible Spending Plan Cafeteria plan under Section 125 of the Internal Revenue Code. The Health Care Flexible Spending Account (HCFSA) is intended to qualify as a self-insured medical reimbursement plan, as defined in Code Section 105(h)(6), and the medical care expenses reimbursed under the HCFSA are intended to be eligible for exclusion from the participating employee s gross income under Internal Revenue Code section 105(b). The Dependent Care Flexible Spending Account (DCFSA) is intended to qualify as a dependent care assistance program, as defined in Code section 129(d), and the dependent care expenses reimbursed under the DCFSA are intended to be eligible for exclusion from the participating employee s gross income under Internal Revenue Code section 129(a). The HCFSA component and the DCFSA component of the plan are separate plans for purposes of administration and for all reporting and nondiscrimination requirements imposed by Internal Revenue Code sections 105 and 129. The HCFSA component also is a separate plan for purposes of applicable provisions of ERISA and COBRA. The FSP provides for the payment of employee premiums with respect to the Medical and Dental Assistance Plan on a before-tax basis, as permitted under Internal Revenue Code section 125. January 1 December 31 (continued) * Eligible store employees are designated as participating in a separate plan from eligible non-store employees for the purpose of Section 105(h) of the Internal Revenue Code and all other nondiscrimination requirements. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 47

74 OTHER INFORMATION Plan funding and sources of contributions Group numbers FSA Plan: Health Care Flexible Spending and Dependent Care Flexible Spending Accounts: The company accounts for employee monthly contributions and uses them to pay claims on the accounts. The company pays the expenses of administering the plan. These payments are offset by any employee contributions that are forfeited under the use or lose rule and by any uncashed benefit checks. Any remaining funds after paying claims and administrative expenses will be distributed to current plan participants on a per capita basis after June 30 following the plan year. Before-Tax Premium Payments: The company accounts for employee premium contributions and uses them to pay claims for self-insured medical and dental plan coverage or for premiums for insured medical and dental coverage. Health Savings Account (HSA) Contributions: Before-tax employee contributions: These contributions are forwarded regularly to the account trustee for the HSA accounts. Company contributions: These contributions are forwarded to the account trustee for the HSA accounts once a year in a lump sum and upon eligibility for a new participant. 48 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

75 Life, accident and disability plans This section contains additional information that applies to: The Phillips 66 Group Life Insurance Plan life, occupational accidental death (OAD) and accidental death and dismemberment (AD&D) benefits; and The Phillips 66 Disability Plan short-term disability (STD) and long-term disability (LTD) benefits. For the Short-Term Disability benefit under the Phillips 66 Disability Plan The Plan Administrator listed on page 5 has the power to make all determinations that the plan requires for its administration and to construe and interpret the plan whenever necessary to carry out its intent and purpose and to facilitate its administration. Right of recovery If the plan pays more than it should have for a claim, it has the right to get that money back. FOR LONG-TERM DISABILITY (LTD) BENEFITS The Phillips 66 Disability Plan s long-term disability benefits insurer has the right to recover from you any amount it determines to be an overpayment under the plan, and you have the obligation to refund any such amount. The insurer s rights and your obligations in this regard also are set forth in the reimbursement agreement you are required to sign when you become eligible for disability benefits under the plan. The reimbursement agreement: Confirms that you will repay all overpayments; and Authorizes the insurer to obtain any information relating to any of the items listed under What if I receive other disability income or benefits? in the separate Long-Term Disability booklet. An overpayment occurs when the insurer determines that the total amount paid by the insurer on your disability claim is more than the total of the long-term disability benefits due under the plan. This includes overpayments resulting from: Retroactive awards received from sources listed in the What if I receive other disability income or benefits? section mentioned above; Fraud; or Any error the insurer makes in processing your disability claim. The overpayment equals the amount the insurer paid in excess of the amount the insurer should have paid under the plan. You have a right to appeal any overpayment recovery. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 49

76 OTHER INFORMATION An overpayment also occurs when payment is made by the insurer under this plan when the payment should have been made under another plan. In that case, the insurer may recover the payment from one or more of the following: Any other insurance company; Any other organization; or Any person to or for whom payment was made. In the case of a recovery from a source other than this plan, the insurer s overpayment recovery will not be more than the amount of the overpayment recovered. The insurer may, at its option, recover the overpayment by: Reducing or offsetting against any future benefits payable under this plan to you or your survivors; Stopping future benefit payments under this plan (including the minimum benefit) which would otherwise be due under this plan. Plan benefit payments may continue when the overpayment has been recovered; or Demanding an immediate refund of the overpayment from you. FOR GROUP LIFE INSURANCE TRAVEL ASSISTANCE BENEFITS For the first 24 months after the payment of travel assistance benefits under the Phillips 66 Group Life Insurance Plan, the Claims Administrator has the right to recover any benefits that the plan has paid under this coverage if the company or a covered person recovers any money from a third party for the travel assistance expenses paid. The Claims Administrator will be reimbursed for any amount paid that was also paid by a third party and will have a lien against the recovery of this amount. This 24-month limitation will not apply if the plan made payment because of fraud committed by the claimant or health care provider, or if the claimant or health care provider has otherwise agreed to make a refund to the Claims Administrator for overpayment of a claim. The Claims Administrator has the right to recover from the covered person for transportation services and/or expenses that were not covered under travel assistance coverage. FOR SHORT-TERM DISABILITY (STD) BENEFITS If it s determined that the Phillips 66 Disability Plan has paid more short-term disability absence benefits than should have been paid under the plan, or the plan has paid short-term disability absence benefits based upon a falsified claim or falsified information, the plan retains the contractual right to recover all excess amounts from the eligible employee, his or her estate, or the person to whom payments were made. Either the Claims Administrator or the Plan Administrator may: Deduct the amount of such overpayment from any subsequent benefits payable to the eligible employee or from other present or future amounts payable under the plan; or Recover such amount by any other method that the Claims Administrator or Plan Administrator shall determine. At the discretion of the Plan Administrator, the eligible employee may be suspended from participation in the plan for the remainder of the current plan year or all future plan years for failure to repay any overpayments or for falsifying a claim for short-term disability absence benefits, including the falsification of any supporting documentation. 50 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

77 Claims and appeals procedures The How to file a claim section in the separate Employee Life, Accidental Death & Dismemberment, Short-Term Disability and Long-Term Disability booklets explains what you or your beneficiary needs to do in order to file a claim for plan benefits. In this section, we ll talk about what to do if a claim is denied. We will say you throughout this section, although we mean you, your beneficiary or anyone else duly authorized to work on your behalf. An authorized representative is A person authorized to file claims or appeals on your behalf. For this person to be considered your authorized representative, one of the following requirements must be satisfied: You have given express written consent for the person to represent your interests; or The person is authorized by law to give consent for you (e.g., parent of a minor, legal guardian, foster parent, power of attorney). INFORMATION AND CONSENTS REQUIRED FROM YOU When you file a claim or appeal, you, your beneficiaries and/or your covered dependents consent to: The release of any information the Claims Administrator or Appeals Administrator requests to parties who need the information for claims processing purposes; and The release of medical or dental information (in a form that prevents individual identification) to Phillips 66 for use in occupational health activities and financial analysis, to the extent permitted by applicable law. In considering a claim or appeal, the Claims Administrator or Appeals Administrator has the right to: Require examination of you and your covered dependents when and as often as required; Have an autopsy performed in the event of death, when permitted by state law; and Review a physician s or dentist s statement of treatment, study models, pre- and posttreatment X-rays and any additional evidence deemed necessary to make a decision. No personnel decisions may be made against you based on the outcomes of the claims and appeals process. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 51

78 OTHER INFORMATION IF A CLAIM IS DENIED In general, the Claims Administrator must notify you of its decision regarding your claim within the following timeframes: For this type of claim: STD, LTD and AD&D (with disability claim) Life and AD&D (without disability claim) Initial determination will be made: Within a reasonable time after the claim is received, but not longer than 45 days. (See the paragraph below for extension rules.) Within a reasonable time after the claim is received, but not longer than 90 days. (See the paragraph below for extension rules.) Sometimes, the Claims Administrator may need more time or information to make a determination regarding the claim (up to 60 more days for disability benefits and up to 90 more days for non-disability benefits). If this happens, you ll be notified in writing of the need for an extension and why the extension is needed. An explanation of the appeals procedures, including time limits that apply. A statement of your right to file a lawsuit in federal court under ERISA section 502(a), if your claim is denied on final appeal. If all or part of your claim is denied, the Claims Administrator will give you a written or electronic notice that will include (among other things): The specific reason(s) for the denial and the specific plan provisions on which the denial is based. A description of any additional material or information you must provide in order for your claim to be approved, and an explanation of why that material or information is necessary. If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to you free of charge upon request (applicable to disability claims only). 52 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

79 HOW TO FILE AN APPEAL Appeals must be filed within: 60 days for a life (including OAD) and AD&D (without disability) claim denial. 180 days for an AD&D (with disability), STD or LTD claim denial. If you miss the deadline, you CANNOT appeal. If all or part of your claim is denied, you can appeal that denial. The goal of the appeals process is to ensure you have a full and fair review of your appeal. Your appeal must be made in writing and must be sent to the appropriate Appeals Administrator as shown below. Type of benefit Group life insurance benefits Life insurance (basic life, supplemental life, dependent life) OAD (store employees) Life insurance (travel assistance benefits) OAD (non-store employees) Accidental Death and Dismemberment (AD&D) insurance Disability benefits Short-term disability (STD) Long-term disability (LTD) Appeals Administrator The Hartford Phillips 66 Group Life/AD&D Claims Unit P.O. Box 2999 Hartford, CT (888) Phillips 66 Plan Administrator Manager HR Shared Services (HRSS) 411 S. Keeler Avenue Bartlesville, OK (918) The Hartford Phillips 66 Group Life/AD&D Claims Unit P.O. Box 2999 Hartford, CT (888) Manager, Benefits Phillips 66 Company c/o Benefits Department P.O. Box 4428 Houston, TX (832) Benefit Management Services Maitland Claim Office The Hartford P.O. Box Lexington, KY (800) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 53

80 OTHER INFORMATION Please indicate in large letters at the top of your letter that your letter is an appeal. In your appeal, you may: Include written comments, documents, records and other information relating to your claim, whether or not those materials were submitted with your initial claim. Request to see and get free copies of all documents, records and other information relevant to your claim. By filing an appeal, you are consenting to the release of relevant health information for claims processing purposes. You may also be required to have a medical exam. You may also have to sign an authorization for release of relevant medical or dental records. No personnel decisions may be made against you based on the outcomes of this review and appeals process. The appropriate Appeals Administrator must make its decision on your appeal within the following timeframes: For this type of appeal STD, LTD and AD&D (disability) Life and AD&D (without disability) The timeframe for a final determination is Within a reasonable time after the appeal is received, but not longer than 45 days Within a reasonable time after the appeal is received, but not longer than 60 days The deadline for a decision on an appeal may be extended. If this happens, you ll be informed in writing. You ll also be told why the extension is needed. For this type of appeal STD, LTD and AD&D (disability) Life and AD&D (without disability) The timeframe for a final determination may be extended Not to exceed 45 days from the initial 45-day determination deadline Not to exceed 60 days from the initial 60-day determination deadline If an appeal is denied If all or part of your claim is denied on appeal, you ll be given a written or electronic notice that will include: The specific reason(s) for the denial. References to each of the specific provision(s) of the plan on which the denial is based. A statement that you are entitled, upon request, to see all documents, records and other information relevant to your claim for benefits, and also that you are entitled to get free copies of that information. If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to you free of charge upon request (applicable to disability claims only). A statement describing any further appeal procedures, including any applicable deadlines, and your right to obtain further information about such procedures. 54 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

81 A statement of your right to file a lawsuit in federal court under ERISA section 502(a). The following statement: You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your state insurance regulatory agency. (Applicable to disability claims only.) The Appeals Administrator s decision is final The Appeals Administrator that makes the final appeals decision acts as a fiduciary under ERISA and has the full discretion and authority to: Make final determinations of all questions relating to eligibility for any plan benefit and to interpret the plan for that purpose; and Make final and binding grants or denials of benefits under the plan. Benefits under the plan only will be paid if the appropriate Appeals Administrator decides in its sole discretion that the applicant is entitled to them. The determination of the appropriate Appeals Administrator on appeal will be final and binding. If you ve gone through the appeals process and still believe you re entitled to a plan benefit, you may file a civil action under Section 502(a) ERISA to recover benefits due under the terms of the plan, to enforce your rights under the terms of the plan, or to clarify your rights to future benefits under the terms of the plan. Any civil action must be filed within the following time frames: For life (including OAD), AD&D and LTD claims, you cannot sue in federal court before 60 days after proof of loss was submitted. Your suit must be filed within three years* from when proof of loss was required. Legal action arising under the Travel Assistance provision under the Group Life Insurance Plan shall be barred unless written notice is received by the Appeals Administrator within one (1) year from the date of the event giving rise to such legal action. For STD claims, you cannot sue in federal court until the first level of appeal is complete. Your suit must be filed within three years from the date of the Plan Administrator s final decision to deny the claim. * If the law of the state in which you live makes the three-year limit void, the action must begin within the shortest time period permitted by law. FRAUDULENT CLAIMS If the plan finds that you or someone on your behalf has submitted a fraudulent claim to the plan, the plan has the right to recover any amounts paid by the plan with respect to fraudulent claims or expenses and may take legal action against you. Upon determining that a fraudulent claim has been submitted, the plan has the right to permanently terminate the coverage provided for you and your dependents under the plan, and the Plan Administrator has the authority to take any actions it deems appropriate to remedy such violations, including pursuing legal action or equitable remedies to recover any payments made by the plan to any party, regardless of when the fraudulent claim was discovered. Such action will not preclude the company from taking other appropriate action. You will have the right to appeal the decision by going through the appeals process that applies to the specific benefit being terminated. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 55

82 OTHER INFORMATION ERISA plan information The plans listed below are governed by a federal law, ERISA, and are subject to its provisions. Phillips 66 Group Life Insurance Plan (includes Accidental Death and Dismemberment Insurance) (These components are commonly referred to as the Life and AD&D Plans) Plan name Type of plan Plan number 502 Plan year and fiscal records Plan funding and sources of contributions Phillips 66 Group Life Insurance Plan Welfare benefit plan providing basic life insurance, supplemental life insurance, dependent life insurance, occupational accidental death coverage and accidental death and dismemberment insurance benefits. Benefits under the plan are provided under the terms and conditions of the plan, and the insurance contracts as determined by the Claims Administrator. Occupational accidental death benefits for non-store employees are funded through the general assets of the company at no cost to eligible employees. The benefit for non-store employees is taxable income, not grossed up for taxes and not subject to interest for the time between death and payment dates. The insurance contracts providing benefits under this plan are incorporated by reference in the Employee Life and Employee AD&D SPDs. January 1 December 31 Except for occupational accidental death (OAD) benefits for non-store employees and travel assistance benefits, benefits are funded through insurance contracts. The costs of basic life, occupational accidental death and travel assistance benefits are paid entirely by the company, with no cost to employees. The costs of supplemental life, dependent life and accidental death and dismemberment insurance benefits are paid entirely by participating employees. Group numbers Life Insurance (The Hartford): Accidental Death and Dismemberment Insurance (The Hartford): S07584 (continued) 56 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

83 Phillips 66 Disability Plan (includes short-term disability component and long-term disability component) (These components are commonly referred to as the STD Plan and the LTD Plan) Plan name Type of plan Plan number 503 Plan year and fiscal records Plan funding and sources of contributions Group numbers Phillips 66 Disability Plan The Phillips 66 Disability Plan is a disability benefit welfare employee benefit plan. Benefits under the LTD Plan are provided under the terms and conditions of the plan and the insurance contract as determined by the Claims Administrator. The insurance contract providing benefits under the LTD Plan is incorporated by reference into the LTD SPD. January 1 December 31 STD Plan disability benefits are funded through the general assets of the company at no cost to eligible employees. LTD Plan disability benefits are funded through an insurance contract. The premium cost is paid entirely by participating employees. STD: Not applicable LTD (The Hartford): GLT OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 57

84 OTHER INFORMATION Severance Pay Plan The information in this section applies to the Phillips 66 Severance Pay Plan. Plan administration For the Severance Pay Plan, the Plan Administrator is the Manager Benefits (or successor) at the address shown below. Manager, Benefits Phillips 66 Company c/o Benefits Department P.O. Box 4428 Houston, TX Phillips 66 Severance Pay Plan Committee The Severance Pay Plan Committee has the power to administer and interpret the Severance Pay Plan, including granting or denying claims for benefits following initial resolution by the Plan Administrator. All interpretations of the plan, findings of fact and resolutions made by the committee are binding, final and conclusive on all parties. Right of recovery If the plan pays you more than it should have, your benefits may be adjusted if: The company or its agents or representatives make an error relating to your eligibility for benefits, calculating benefits or administering the plan; or You or your beneficiary provide incorrect information (or fail to state a material fact) in an application or claim for benefits or in response to the company s request for more information. Any adjustments could mean that you or your beneficiary would have to repay part or all of a payment made to you or your beneficiary. Claims and appeals procedures In this section, we ll talk about what to do if you have been denied a benefit by the plan. We ll say you throughout this section, although we mean you or anyone else duly authorized to work on your behalf. An authorized representative is A person authorized to file claims or appeals on your behalf. For this person to be considered your authorized representative, one of the following requirements must be satisfied: You have given express written consent for the person to represent your interests; or The person is authorized by law to give consent for you (e.g., parent of a minor, legal guardian, foster parent, power of attorney). 58 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

85 HOW TO FILE A CLAIM You may file a claim if you believe you are entitled to benefits under the Severance Pay Plan but do not receive them. The claim must be presented in writing to the Plan Administrator within 24 months after your last date of employment with the company. If your claim is denied in whole or in part by the Plan Administrator, you will receive a written notice of the denial within a reasonable period of time, but not later than 90 days after receipt of the claim by the Plan Administrator. If special circumstances require an extension of time for processing, a decision will be made within a reasonable period of time, but in no case later than 180 days after receipt of your claim. If all or part of your claim is denied, you will be given written notice that will include: The specific reason(s) for the denial. References to each of the specific provision(s) of the plan on which the denial is based. A description of any additional material or information you must provide in order for your claim to be approved, and an explanation of why that material or information is necessary. An explanation of the appeals procedures, including time limits that apply. A statement of your right to file a lawsuit in federal court under ERISA section 502(a), if your claim is denied on appeal. Review of claim denial If all or part of your claim is denied, you can appeal that denial by filing a written request for review with the Severance Pay Plan Committee within 60 days after the date you received written notice of denial. Your appeal must be made in writing and sent to the Severance Pay Plan Committee at the following address: Phillips 66 Severance Pay Plan Committee 411 S. Keeler Avenue Bartlesville, OK (918) Please indicate in large letters at the top of your letter that your letter is an appeal. The committee will review your appeal, make a decision and let you know about your appeal within 60 days after you file it. If special circumstances require an extension of time for processing, a decision will be made within a reasonable period of time, but in no case later than 120 days after receipt of your request for review. If the extension of time is due to your failure to provide information necessary to decide your claim, the period of time for deciding the appeal will be suspended until you respond to the request for additional information. If all or part of your claim is denied on appeal, you will be given written notice that will include: The specific reason(s) for the denial. References to each of the specific provision(s) of the plan on which the denial is based. A statement that you are entitled, upon request, to see all documents, records and other information relevant to your claim for benefits, and to get free copies of that information. A statement of your right to file a lawsuit in federal court under ERISA section 502(a). You have the right to review, free of charge, all pertinent documents, records and other information of the plan that relate to your claim and to submit issues and comments in writing. OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 59

86 OTHER INFORMATION You must exhaust your administrative remedies by properly filing a claim for benefits and then requesting a review of any complete or partial claim denial before you seek a review of your claim for benefits in a court of law. A decision on a review of a claim denial will be the final decision of the committee. If you ve gone through the appeals process and still believe you re entitled to a plan benefit, you may file a civil action under ERISA section 502(a) to recover benefits due under the terms of the plan, to enforce your rights under the terms of the plan, or to clarify your rights to future benefits under the terms of the plan. Any civil action must be filed within three years from the date of the committee s final decision on appeal. ERISA plan information The plan is governed by a federal law, ERISA, and is subject to its provisions. Phillips 66 Severance Pay Plan (Commonly referred to as the Severance Pay Plan) Plan name Type of plan Plan number 507 Plan year and fiscal records Plan funding and sources of contributions Phillips 66 Severance Pay Plan Welfare benefit plan January 1 December 31 The company pays reasonable expenses necessary for the operation of the plan and pays benefits from the general assets of the company. Neither employees nor participants are required or permitted to make contributions to the plan. The plan is not insured. 60 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

87 Glossary Accidental injury Active employee Actively at work For the life and AD&D options under the Group Life Insurance Plan Actively at work For the LTD Plan Activities of daily living (ADLs) Affiliate Trauma or damage to a part of the body that occurs as the result of a sudden, unforeseen external event that occurs by chance and/or from unknown causes and that s not contributed to by disease, sickness or bodily infirmity. An accidental injury doesn t include: Injury incurred while in active, full-time military; and Injury incurred while committing a felony or other serious crime or assault. An employee who s on the direct U.S. dollar payroll. Means at work with your employer on a day that is one of your employer s scheduled work days. On that day, you must be performing for wage or profit all of the regular duties of your job: In the usual way; and For your usual number of hours. We will also consider you to be actively at work on any regularly scheduled vacation day or holiday only if you were actively at work on the preceding scheduled work day. Performing all of the regular duties of your job at a place required by the employer. Includes weekends, vacation, holidays, leaves of absence (excluding leave of absence-labor Dispute) that are not due to disability as defined for LTD benefits eligibility, and business closures. Bathing Washing yourself by sponge bath in either a tub or shower, including getting into or out of the tub or shower with or without equipment or adaptive devices; Dressing Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs; Toileting Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene; Transferring Moving into or out of bed, chair or wheelchair with or without such equipment as canes, quad canes, walkers, crutches, grab bars or other supportive devices including mechanical or motorized devices; Continence Being able to maintain control of bowel or bladder function; or if unable to maintain control of bowel or bladder functions, being able to perform associated personal hygiene (including caring for catheter or colostomy bag); and Eating Feeding yourself by getting food into your body from a receptacle (such as a plate, cup or table), by a feeding tube or intravenously. A member of the affiliated group, which consists of Phillips 66 and entities of which Phillips 66 has at least a 5% ownership interest. A person, company or other legal entity that is not in the affiliated group is an unrelated entity. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 61

88 OTHER INFORMATION Affiliate providers Anesthesia Annual deductible Annual out-of-pocket maximum Annual pay Appeals Administrator Appropriate care and treatment Beneficiary, beneficiary(ies) A network of licensed clinical counselors who contract with ValueOptions to provide assessment, referral and brief counseling services (45 to 60 minutes per session). These individuals must possess at least a Master s level degree and may include licensed social workers, professional counselors, marriage and family therapists or psychologists. Charges for an anesthetic and its administration. The amount you pay each calendar year before the plan pays benefits. For the Consumer Plan, the PPO Plan, the Medicare-Eligible PPO Plan and the Comprehensive Dental option, there are two types of deductibles the annual individual deductible and the annual family deductible. The plan defines amounts that apply to the annual deductible. The maximum amount you pay each calendar year for covered services. The out-of-pocket maximum is the type of amounts defined by the plan that generally apply to the annual deductible. Once you reach your out-of-pocket maximum, the plan pays 100% for most covered services. For basic and supplemental life insurance benefits, pay means base salary and regularly scheduled overtime excluding overtime resulting from the 19/30 work schedule, commissions and bonuses. For these employees, their base salary is their pay for determining life insurance benefits. An entity that processes appeals regarding benefit claims. Medical care and treatment that meet all of the following: It s received from a physician whose medical training and clinical experience are suitable for treating your disability; It s necessary to meet your basic health needs and is of demonstrable medical value; It s consistent in type, frequency and duration of treatment with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies; It s consistent with the diagnosis of your condition; and Its purpose is maximizing your medical improvement. The person(s) or entity(ies) you designate to receive specific plan benefits in the event of your death. (continued) 62 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

89 Brand-name drug Claims Administrator COBRA COBRA Administrator Code Coinsurance Comparable employment level Comparable pay Concurrent care claim Consultation and X-rays (by a dentist) Copay (also known as a copayment) A prescription drug that s protected by a trademark registration. Brand-name drugs include preferred brand drugs and non-preferred brand drugs. Preferred brand drugs (also known as preferred drugs) are included on the Prescription Drug Claims Administrator s list of carefully selected brand-name medications that can assist in maintaining quality care for patients, while lowering the plan s cost for prescription drug benefits. The Prescription Drug Claims Administrator enlists an independent Pharmacy and Therapeutics Committee to review each drug on the list for safety and effectiveness. Non-preferred brand drugs are brand-name drugs that aren t on the Prescription Drug Claims Administrator s list of preferred drugs. The entity responsible for processing benefit claims and for any other functions as explained in this booklet and in any health and welfare booklet comprising the respective summary plan description. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that provides for continuation coverage for employees/retirees and covered dependents who, under certain circumstances, would otherwise lose their group health coverage. The entity responsible for administering COBRA eligibility and for any other functions as explained in this booklet and in any health and welfare booklet comprising the respective summary plan description. The Internal Revenue Code of 1986, as amended. The percentage of a covered expense that you re responsible for paying. A new job has a comparable employment level to a current job if it is no lower than one level below the level of the current job. For this purpose, level means salary grade level established by the company. A new job has comparable pay to a current job if weekly base wages or base salary for the new job including any pay for regularly scheduled overtime, but excluding overtime due to the 19/30 program are equal to or greater than 80% of the weekly pay for the current job. An approved ongoing course of treatment to be provided over a period of time or for a specified number of treatments. Dental services requested by a physician to rule out possible dental problems as a cause of a patient s medical condition. Under the PPO Plan, a fixed amount you pay each time you receive certain services or purchase prescription drugs. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 63

90 OTHER INFORMATION Corporate event Covered accident Covered expenses Creditable coverage Creditable prescription drug coverage Any of the following events: The sale of an asset or assets by the company or by a member of the employer to one or more unrelated entities. The sale of stock of an entity that is owned by the company or by a member of the employer to one or more unrelated entities. The formation of a joint venture between the company or a member of the employer and one or more unrelated entities. The sale of an interest in a joint venture by the company or a member of the employer to one or more unrelated entities. The cessation of the company s role as operator of a joint venture or business, and the commencement of that role by one or more unrelated entities. The transfer of a job, function or service formerly performed by employees of the company or a member of the employer to one or more unrelated entities. An event not otherwise excluded by the insurance contract that results in a bodily injury or death for which the Claims Administrator determines AD&D benefits are payable. Reasonable and customary charges for medically necessary services and supplies that are: Recommended by the attending physician; and Required in connection with the treatment of accidental bodily injury, disease or pregnancy, or in connection with the care and treatment of a newborn dependent child prior to release from a hospital. Under federal law, health plans may deny coverage for pre-existing conditions only under limited circumstances and for a limited period of time. If a health plan does deny pre-existing condition coverage for the permitted time period, that period may be reduced by periods of prior health coverage, as long as the new coverage starts within 62 days of the date the prior coverage ended. Prescription drug coverage that is, on average, at least as good as the Medicare standard prescription drug coverage. This determination of creditable coverage is defined by the Centers for Medicare and Medicaid Services (CMS) and is made by independent actuarial attestation. (continued) 64 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

91 Custodial care Date of layoff Services including room, board and other personal assistance provided primarily to assist a covered individual in the activities of daily living (eating, dressing, bathing, etc.). Custodial care includes, but is not limited to, care rendered to a patient: Who is mentally or physically disabled, and such disability is expected to continue and be prolonged indefinitely; Who requires a protected, monitored and/or controlled environment; or Who isn t under active and specific medical, surgical and/or psychiatric treatment that will reduce the disability to the extent necessary to enable the patient to function outside of the protected, monitored and/or controlled environment. The last day a participant who is laid off is an employee as reflected by the employment end date recorded in the company s personnel records. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 65

92 OTHER INFORMATION Disabled, disability For Employee Medical, Employee Dental, Employee Vision, Retiree Medical and the EAP Disabled, disability For COBRA qualified beneficiaries Disabled, disability For the Flexible Spending Plan s Dependent Care Flexible Spending Account Disabled, disability For the dependent life and AD&D options under the Group Life Insurance Plan Disabled, disability For the STD Plan Disabled, disability For the LTD Plan An otherwise eligible child is permanently and totally disabled if he/she is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. An eligible child will not be considered to be permanently and totally disabled unless you furnish proof establishing permanent and total disability. The plan reserves the right to require, at its own expense, an independent medical or psychological evaluation to verify the child s disabled status. You qualify for Social Security disability benefits during the first 60 days of COBRA coverage. A spouse who is physically or mentally incapable of self-care and has the same principal place of abode as you for more than 50% of the current calendar year. The inability to perform activities of a person of like age and gender. A non-occupational illness or injury (see page 79) that prevents an eligible employee from performing, for a temporary period of time, the regular duties of his or her job with the company or other normal activities. Due to your accidental bodily injury, sickness, mental illness, substance abuse or pregnancy, you are receiving appropriate care and treatment from a physician on a continuing basis, and: During your elimination period and the next 24-month period, you re unable to perform the material duties of your regular job with the company and are unable to earn more than 80% of your pre-disability earnings or indexed pre-disability earnings; or After the 24-month period, you re unable to earn more than 60% of your indexed pre-disability earnings from any employer in your local economy at any gainful occupation for which you are reasonably qualified, taking into account your training, education, experience and pre-disability earnings. Your loss of earnings must be a direct result of your sickness, pregnancy or accidental injury. The Claims Administrator has the sole authority for determining disability. Economic factors, such as, but not limited to, recession, job obsolescence, pay cuts and job-sharing will not be considered in determining whether you meet the loss of earnings test. If your job requires a license, loss of license for any reason doesn t, in itself, constitute disability. (continued) 66 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

93 Domestic partner For Employee Medical, Employee Dental, Employee Vision, the EAP, the Flexible Spending Plan and Retiree Medical EAP providers Emergency care A person who has demonstrated a commitment to a long-term relationship with you. You and your domestic partner must meet all of the following requirements: You intend to remain each other s sole domestic partner indefinitely; You re both at least 18 years old (or of legal age); You re both mentally competent to enter into contracts; You re not related by blood; You haven t been married to each other; Neither you nor your domestic partner are married to anyone else; You have the same principal place of abode for the tax year; Your domestic partner is a member of your household for the tax year and intends to remain so indefinitely; You have provided more than 50% of your domestic partner s total support for the tax year; The relationship does not violate local law; and You lived together for six months before enrolling your domestic partner, are jointly responsible for each other s welfare and are financially interdependent. Must meet the criteria to be Master s level counselors, have a minimum of two years experience providing EAP services and three years experience in the community where they are practicing; Are not qualified to prescribe or dispense medications; and Specialize in workplace issues and performance problems, organizational stresses, substance abuse assessment and issues, and short term counseling for life concerns. Treatment provided in a hospital s emergency room to evaluate and stabilize a recent and severe medical condition that arises suddenly and, in the judgment of a reasonable person, requires immediate care to avoid: Placing the person s health in serious jeopardy; Serious impairment to bodily function; Serious dysfunction of a body part or organ; or In the case of a pregnant woman, serious jeopardy to the health of the fetus. Note: Follow-up care after stabilization is not emergency care. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 67

94 OTHER INFORMATION Employee For the Severance Pay Plan Employer For the Severance Pay Plan Employment end date Entitled to Medicare ERISA Evidence of insurability (EOI), evidence of good health External review Family medical leave of absence (FMLA) Foster child Full-time student A person who is on the company s direct U.S. dollar payroll, for whom the company or its agent issues a form W-2 to report compensation to the Internal Revenue Service, and who is in a regular full-time or regular part-time employment status on the date of layoff. The term employee shall not include: Temporary personnel, intermittent personnel, leased employees within the meaning of Internal Revenue Code Section 414(n), and other non-regular employees of the company; or A person who is retroactively reclassified as a common-law employee by the Internal Revenue Service or by a court. Phillips 66 and the members of its controlled group of corporations as that term is defined in section 414(b) of the Code and entities under common control with Phillips 66 as defined in section 414(c) of the Code. The last day of an employee s employment as recorded in the company s personnel records. An individual who: Is receiving Medicare benefits; or Would receive such benefits if he or she made application to the Social Security Administration. Employee Retirement Income Security Act of 1974, as amended. A statement providing your medical history. The Claims Administrator will use this statement to determine your insurability under the applicable plan. A review of a denied claim or appeal by an Independent Review Organization (IRO). FMLA leave is family or medical leave taken under the terms of the Family and Medical Leave Act of 1993, as amended. An individual under the age of 26 who is placed with you by an authorized placement agency or by judgment, decree or other order of any court of competent jurisdiction, and who is your eligible foster child for purposes of Code section 152(f)(1)(A)(ii). Under the applicable state law, the maximum age for a foster child may be less than 26. An eligible child (or eligible spouse, for the DCFSA) as defined under the applicable plan who s enrolled for the number of hours or courses the school considers to be full-time attendance during each of five calendar months during the calendar year in which the taxable year of the covered employee begins. A child (or spouse under the DCFSA) who s attending school only at night isn t considered to be a full-time student. However, full-time attendance at school can include some attendance at night as part of a full-time course of study. (continued) 68 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

95 General Release of Liability or Release Generic drug Group health plan For Employee Medical, Retiree Medical Group health plan For the Flexible Spending Plan HIPAA A waiver and release signed by the participant, or, if the participant is deceased, signed by the participant s spouse or the representative of the participant s estate, in a form acceptable to the company, of all claims, whether or not asserted, arising out of or related to the participant s employment or termination from employment. Such waiver and release shall apply to claims against the company or other members of the affiliated group by participants, including without limitation any claims of discrimination arising out of or incident to a participant s employment and termination thereof, other than claims made for work-related injuries under applicable Workers Compensation statutes, claims for benefits payable in accordance with the terms of employee benefit plans of the company, and claims regarding reimbursements for business associated expenses the participant may have. A prescription drug that contains the same active ingredients, in the same dosage form, as the brand-name drug, and is subject to the same U.S. Food and Drug Administration (FDA) standards for quality, strength and purity as its brand-name counterpart. Some generics are made by the same pharmaceutical firms that produce the brand names. Generally, generic medications cost less because they don t require the same level of sales, marketing research and development expenses associated with brands. A plan that provides health care coverage and is maintained by an employer. When used in connection with special enrollment rights, the term means coverage under a plan that provides health care coverage and is maintained by an employer. The Health Insurance Portability and Accountability Act of 1996, as amended. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 69

96 OTHER INFORMATION Home health care agency An agency or organization that provides a program of home health care and which fully meets one of the following three tests: It s approved under Medicare; It s established and operated in accordance with the applicable licensing and other laws; or It meets all of the following tests: It has the primary purpose of providing a home health care delivery system bringing supportive services to the home; It has a full-time administrator; It maintains written records of services provided to the patient; Its staff includes at least one registered nurse (R.N.) or it has nursing care by an available R.N.; and Its employees are bonded and it provides malpractice insurance. (continued) 70 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

97 Hospice care Care and support services given to a terminally ill person and to his or her family. An individual who is terminally ill has a medical prognosis of 12 months or less to live. Hospice care enables terminally ill patients to remain in the familiar surroundings of their home for as long as they can. While benefits for necessary hospice care can be on either an inpatient or outpatient basis, about 90% of patients can be adequately treated using outpatient hospice. To qualify for entry into a hospice program, the patient, the family and the attending physician must all accept the inevitability of the death process and relinquish all prospects of medical treatment that might aggressively prolong life, including artificial life support systems. A hospice care agency is an agency that provides counseling and incidental medical services, such as room and board, for a medically ill individual, and that: Is approved under any required state or government Certificate of Need; Establishes policies governing the provision of hospice care; Provides an ongoing quality assurance program, which includes reviews by physicians other than those who own or direct the agency; Provides 24-hours-a-day, seven-days-a-week service; Is under the direct supervision of a duly qualified physician; Has a nurse coordinator who is a registered nurse with four years of full-time clinical experience. Two of these years must involve caring for terminally ill patients; Has a social service coordinator who s licensed in the area in which it s located; Provides hospice services as its main purpose; Has a full-time administrator; and Maintains written records of services given to the patient established and operated in accordance with any applicable state laws. A hospice that s part of a hospital will be considered a hospice for the purposes of this plan. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 71

98 OTHER INFORMATION Hospital Inactive disability status Independent Review Organization (IRO) Indexed pre-disability earnings Ineligible dependent Infertility An institution engaged primarily in providing medical care and treatment of sick and injured persons on an inpatient basis and: Is accredited as a hospital by the Joint Commission on Accreditation of Health Care Organizations; Is approved by Medicare as a hospital; or Meets all of the following tests: It maintains diagnostic and therapeutic facilities on the premises for surgical and medical diagnosis and treatment of sick and injured persons by or under the supervision of a staff of physicians; It continuously provides 24-hours-a-day nursing service by or under the supervision of registered graduate nurses (R.N.) on the premises; and It s operated continuously, with organized facilities for operative surgery on the premises. A participant is in inactive disability status if his or her status as an employee has not been terminated but he or she is not performing services due to disability. Exception: Inactive disability status shall not include the period of time during which a participant is eligible for short-term disability benefits under the company s Short-Term Disability Plan or successor plan or program. An entity that conducts independent external reviews of denied claims and appeals under federal external review procedures approved by the National Association of Insurance Commissioners. Your pre-disability earnings (as of the day before you begin your elimination period, plus any changes made to your pay during your elimination period). If you have been continuously receiving monthly LTD benefits under the plan, each year (on the anniversary of the date your LTD benefit payments began), your pre-disability earnings (not your LTD benefit amount) are adjusted by the lesser of: 10%; or The current annual percentage increase in the Consumer Price Index (CPI), as published by the U.S. Department of Labor. Note: This adjustment applies to your pre-disability earnings and not directly to your LTD benefit amount. A dependent who does not meet a plan s dependent eligibility requirements or is otherwise disqualified from eligibility. The condition of a presumably healthy covered person who is unable to conceive or produce conception after: For a woman who is under 35 years of age: One year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or For a woman who is 35 years of age or older: Six months or more of timed, unprotected coitus, or six cycles of artificial insemination. (continued) 72 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

99 Injury For the AD&D option under the Group Life Insurance Plan Institutes of Excellence Network Investigational and/or experimental Layoff, laid off For the Severance Pay Plan A bodily injury directly caused by a covered accident, which is independent of all other causes, and occurs while the individual is enrolled in the plan (insured under the insurance contract) and is not otherwise excluded under the terms of the plan and/or the insurance contract. The following are not considered to be loss resulting from injury: Sickness or disease, except pus-forming infection that occurs through an accidental wound; and Medical or surgical treatment of a sickness or disease. The Claims Administrator s participating network for transplants and transplant-related services, including evaluation and follow-up care. Only hospitals that have exhibited successful clinical outcomes, met quality-of-care standards and agreed to acceptable contractual terms participate in the Institutes of Excellence Network. A drug, device, procedure or treatment that has: Insufficient outcomes data available from controlled clinical trials published in the peer-review literature to prove its safety and effectiveness for the disease or injury involved; Not received FDA approval for marketing (if required); Been deemed, in writing, to be experimental, investigational or for research purposes by a recognized national medical society, regulatory agency or the treating facility; or Not met generally accepted standards of medical practice in the United States. These terms apply if all the requirements of (1) and (2) below are met and if (3) below does not apply to the termination of employment: (1) Except as provided in (3) below, the term layoff or laid off applies if: (a) The company gives the participant notice of layoff; (b) The participant s employment is involuntarily terminated with the company and with all members of the employer following such notice of layoff, on a date determined by the company; and (c) The facts are as described in (i), (ii) or (iii) below: (i) The participant is not in salary grade level 21 or 22, and the termination of employment is prior to a Change in Control and is caused by a reduction in force, a job elimination, a corporate event or is designated as a layoff by the Chief Executive Officer of Phillips 66; or (ii) The participant is in salary grade level 21 or 22, and the termination of employment is prior to a Change in Control and is designated as a layoff by the Chief Executive Officer of Phillips 66; or (iii) The termination of employment is on or after a Change in Control and is either caused by a reduction in force, a job elimination, a corporate event, or designated as a layoff by the Chief Executive Officer of Phillips 66. (definition continued on next page) (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 73

100 OTHER INFORMATION Layoff, laid off (continued) For the Severance Pay Plan Layoff pay (2) For purposes of (1)(c)(i) and (1)(c)(iii) above, in order for the elimination of a job (whether or not the elimination was in connection with a reduction in force) other than the job currently assigned to the participant to constitute causation for the termination of the participant s employment, the relationship between the job eliminated and the job currently assigned to the participant must be as described in either subparagraph (a) or (b) below: (a) The job eliminated is not lower than two levels below the level of the job currently assigned to the participant as of the date the job is eliminated, with level meaning salary grade levels established by the company; or (b) The job eliminated has weekly pay that is at least 70% of the weekly pay of the job currently assigned to the participant as of the date the job is eliminated. If the eliminated job is not assigned to an employee at the time of its elimination, the pay shall be the mid-point pay for the salary grade level of the eliminated job. (3) Provided, however, whether or not the company has given a participant notice of layoff, the participant s termination of employment shall not be considered a layoff if any of the following apply: (a) The participant resigns as of a date prior to the date specified for layoff in the notice of layoff; (b) The participant s employment is terminated because he or she failed to accept, within seven calendar days of the offer, a job offered by an employer at comparable pay, at a comparable employment level, and not in the same geographical area for which he or she will receive relocation assistance; (c) The participant s employment is terminated because he or she failed to accept, within seven calendar days of the offer, a job offered by an employer at comparable pay, at a comparable employment level and in the same geographical area; (d) The participant s employment is terminated because he or she failed to accept, within seven calendar days of the offer, a transfer job at comparable pay offered by an affiliate that is not an employer made pursuant to a mutual agreement between the company and the affiliate providing for such transfer job offer; or (e) The participant accepts any transfer job offered by an affiliate that is not an employer made pursuant to a mutual agreement between the company and the affiliate providing for such transfer job offer. The sum of basic benefits and, if applicable, supplemental benefits a participant is entitled to receive from the plan. (continued) 74 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

101 Leave of absence Legally adopted For Employee Medical, Employee Dental, Employee Vision, the EAP and Retiree Medical Legally adopted For the dependent life and AD&D options under the Group Life Insurance Plan Lifetime maximum For Employee Medical, Employee Dental, Retiree Medical Local economy A direct U.S. dollar payroll status that may allow an employee to continue participation for a limited period of time in certain benefit programs in which he or she was participating as an active employee prior to going on leave of absence status. For leaves, refer to the appropriate leave policy for a complete definition. For a leave of absence-labor Dispute, the company places an active employee on this leave for the time when he or she is not working due to a labor dispute. Generally, benefits are not available during a leave of absence- Labor Dispute. For a child (must be under age 18) to be considered the legally adopted son or daughter of the (i) covered employee and/or the covered employee s eligible spouse or (ii) covered employee s eligible domestic partner, as applicable, a final order or final decree of adoption has been issued by a court of competent jurisdiction in the United States, and that the persons shown as the parents of the adopted child are either the (i) covered employee and/or his or her spouse or (ii) covered employee s domestic partner, and the same person(s) are named as parents (with all state statutory parental obligations) in the decree or order evidencing the final adoption. The parent-child relationship is established when the adoption is effective and final under state law. To be legal, an adoption must be valid under the law of the state where the adoption took place. At least one party to the adoption (either the child or adopting parent) must have been domiciled or actually residing in that jurisdiction at the time of adoption. Determined in accordance with the provisions of the law of the state in which you reside. Includes a child from the date of placement with adopting parents until the date of the legal adoption. The maximum amount payable by the plan for a covered individual throughout his or her lifetime (cumulative total among all self-insured medical options that covered the person). The geographic area surrounding your place of residence which offers reasonable employment opportunities. It s an area within which it would not be unreasonable for you to travel to secure employment. If you move from the place you resided on the date you became disabled, both your former place of residence and your current place of residence will be looked at in determining local economy. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 75

102 OTHER INFORMATION Maintenance medication Marriage Marriage and family therapist A prescription drug prescribed for long-term treatment of conditions such as high cholesterol or high blood pressure. Certain maintenance medications may also be considered a preventive prescription drug and, in addition, be subject to those plan provisions. The following categories may include maintenance medications: Anti-infectives. Autonomic and CNS drugs, neurology and psych. Cardiovascular, hypertension and lipids. Endocrine therapy. Diabetes therapy. Musculoskeletal and rheumatology. Obstetric and gynecology. Urological. Ophthalmology. Respiratory, allergy and cough and cold. Hematinics and electrolytes. Gastroenterology. Drugs on the plan s maintenance medication list may change, depending upon the following: Clinical appropriateness of dispensing the drug in larger quantities (for example, monitoring requirements, methods of administration, etc.); Days supply limitations (for example, state regulations, stability issues, etc.); Supply limitations (for example, product availability, exclusive distribution, drug recall, etc.); and Sensitive therapies (for example, extreme psychiatric conditions, etc.). Any marriage that is valid in the state or jurisdiction in which the marriage was entered into, regardless of the employee s place of domicile. A person who has completed the necessary education and training to meet the licensing or certification requirements of the governmental body having jurisdiction over such licensing or certification where the person renders service to a participant or dependent. (continued) 76 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

103 Medically necessary For Employee Medical and Retiree Medical Medically necessary For Employee Dental In order to be covered, a service, procedure, supply or treatment must be medically necessary. These are health care or dental services, and supplies or prescription drugs that a physician, other health care provider recognized by the plan or dental provider, exercising prudent clinical judgment, would give to a patient for the purpose of: Preventing; Evaluating; Diagnosing; or Treating: An illness; An injury; A disease; or Its symptoms. The provision of the service, supply or prescription drug must be: In accordance with generally accepted standards of medical or dental practice; Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient s illness, injury or disease; Not mostly for the convenience of the patient, physician, other health care provider recognized by the plan or dental provider; and No more costly than an alternative service or sequence of services generally considered medically equivalent and at least as likely to produce the same therapeutic or diagnostic results as to the diagnosis or treatment of that patient s illness, injury or disease. For these purposes generally accepted standards or medical or dental practice means standards that are based on credible scientific evidence published in peer-reviewed literature. They must be generally recognized by the relevant medical or dental community. Otherwise, the standards are consistent with physician or dental specialty society recommendations. They must be consistent with the views of physicians or dentists practicing in relevant clinical areas and any other relevant factors. Services that are necessary for the diagnosis and are given at the appropriate level of care. This determination is made by the Claims Administrator. The fact that a procedure or level of care is prescribed by a dentist does not mean that it is medically necessary or that it is covered under the plan. In certain circumstances, a medically necessary procedure may be covered partially by your medical plan and not your dental plan. In this circumstance, it may be necessary to submit a claim under both your medical and dental plans. Ultimately, it is the responsibility of you and your dentist to determine the appropriate course for dental treatment in any given case, regardless of whether it appears the plan will pay the cost of such care. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 77

104 OTHER INFORMATION Mental health, mental health condition, mental health disorder For Employee Medical and Retiree Medical Mental illness For the LTD Plan Motor vehicle Negotiated rate Network deficiency Network provider Non-covered expenses A medically recognized psychological, physiological, nervous or behavioral condition affecting the brain (excluding alcoholism, substance abuse or other addictive behavior) that can be diagnosed and treated by medically recognized and accepted methods. Conditions recognized in the most current American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV), or its successor publication are included in this definition. A mental disorder as listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. A Mental Illness may be caused by biological factors or result in physical symptoms or manifestations. For the purpose of the LTD Plan, mental illness does not include the following mental disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders: Mental retardation; Pervasive developmental disorders; Motor skills disorder; Substance-related disorders; Delirium, dementia, and amnesic and other cognitive disorders; or Narcolepsy and sleep disorders related to a general medical condition. A self-propelled, four or more wheeled vehicle not being used as a common carrier, including a: Private passenger car, station wagon, van or sport utility vehicle; Motor home or camper; or Pick-up truck. Motor vehicle does not include farm equipment, snowmobiles, all-terrain vehicles, lawnmowers or any other type of equipment vehicles. Common carrier is a conveyance operated by a concern, other than the company, organized and licensed for the transportation of passengers for hire and operated by that concern. It excludes conveyances hired or used for a sport, gamesmanship, contest, sightseeing, observatory and/or recreational activity, regardless of whether such conveyance is licensed. The maximum charge a network provider has agreed to charge for a service or supply covered by the plan. A situation in which the Claims Administrator lacks network physicians and hospitals for certain specialties within a provider network. A health care provider, hospital or facility in the United States that the Claims Administrator has designated as part of its provider network for the service or supply being provided. Also known as a preferred provider. Services, treatments and diagnostic procedures not covered under the plan. (continued) 78 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

105 Non-emergency use of an emergency room Non-network pharmacy Non-network provider (also known as non-preferred provider) Non-occupational accident For OAD benefits under the Group Life Insurance Plan Non-occupational illness or injury Non-store Normal activities Notice of layoff Treatment received in a hospital emergency room for a non-emergency while a person isn t a full-time inpatient. A pharmacy that s not in the Prescription Drug Claims Administrator s participating pharmacy network. A health care provider who has not contracted to furnish services or supplies at a negotiated rate. An accident that is not considered an occupational accident. An illness or injury that does not arise out of (or in the course of) any work for profit or result in any way from an illness or injury that does. An illness or injury will be deemed to be non-occupational regardless of cause if proof is furnished that the person was covered under any type of Workers Compensation law and they are not covered for that illness under such law. For example, a non-occupational illness or injury includes, but is not limited to, the flu, a cold, and physician-directed absences during or after a pregnancy. Employee jobs that are not classified in the personnel systems of the employer as retail marketing store. For a dependent, this means the dependent is not confined in a hospital or a place of residence and is able to perform the normal and customary activities of a person of like age and gender. A written notice provided by the company to the participant in a form acceptable to the Plan Administrator stating the date of layoff. Prior to a Change in Control, such notice is a notice of layoff only if approved by: The Chief Executive Officer of Phillips 66 in the case of an employee who, on the date the company gives notice of layoff, is in salary grade levels 21 or 22; The Vice President of Human Resources of Phillips 66 in the case of an employee who, on the date the company gives notice of layoff, is in salary grade levels 19 or 20; or The Business Line Human Resources General Manager (HRLT) in the case of an employee who, on the date the company gives notice of layoff, is in salary grade levels 18 or below. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 79

106 OTHER INFORMATION Occupational accident Occupational illness or injury Occupational therapy An accident that occurs while you re performing your job duties either at your job site or while traveling on company business (at Phillips 66 s expense). The purpose of your business travel must be to further company business, and the trip must involve a company-authorized assignment that requires you to travel. Traveling on business starts when you leave from your residence, regular place of employment or other location (whichever occurs last) for the purpose of traveling to the destination of the business trip. The business trip ends when you return to or arrive at your residence or your regular place of employment (whichever occurs first). Everyday travel to and from work and any personal deviation does not qualify as business travel. Personal deviation is any travel or activity not reasonably related to the business of the company; or not incidental to the business trip and not at the expense of the company. An illness or injury that arises out of (or in the course of) any activity in connection with employment or self-employment whether or not on a full time basis or result in any way from an injury or illness that does. Therapy in which the principal element is some form of productive or creative activity. While similar to physical therapy, occupational therapy focuses on helping an individual develop finer, more delicate movements, such as coordination of the fingers. Such therapy is covered by the plan when it s rendered by a qualified physical therapist or occupational therapist for an appropriate diagnosis as determined by the Claims Administrator. Occupational therapy for activities to occupy a patient s time and interest while being treated isn t covered by the plan. Occupational therapy also does not include educational training or services designed to develop physical function. (continued) 80 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

107 Other health insurance coverage Outpatient surgical facility/ambulatory surgical center The term, as used in connection with the special enrollment rights, means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical policy or certificate, hospital or medical plan contract, or health maintenance organization contract offered by a health insurance issuer. Health insurance coverage includes group health insurance coverage and individual health coverage. Certain types of coverage are not considered other health insurance coverage, such as: Coverage only for accident, or disability income insurance. Coverage issued as a supplement to liability insurance. Liability insurance. Workers Compensation or similar insurance. Credit-only insurance. Coverage for on-site medical clinics. Part A, Part B or Part D of Medicare. Medicaid, a State child health plan or the Children s Health Insurance Program. Medical and dental care for members and former members of the armed services. Medical care program of Indian Health Services or of a Tribal organization. Federal Employee Health Benefit Program. Peace Corps health plan. Public health plan (defined to be a plan of a state, county or other political subdivision). Health coverage provided by foreign governments (e.g., Canadian health care system). A surgery center or hospital outpatient department. Charges for outpatient services and supplies incurred in relation to a surgical procedure performed onsite are covered, provided the procedure: Isn t expected to: Result in extensive blood loss; Require major or prolonged invasion of a body cavity; or Involve any major blood vessels; Can safely and adequately be performed only in a surgery center or in a hospital; and Isn t normally performed in the office of a physician or a dentist. Outpatient services and supplies are furnished by the center/hospital on the day of the procedure. No benefit is paid for charges incurred while the person is confined as a full-time inpatient in a hospital. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 81

108 OTHER INFORMATION Participant Pay Personal leave of absence Physical therapy Physician For Employee Medical, Employee Dental, the STD Plan and Retiree Medical An employee/retiree who has met the eligibility requirements of the plan and, when applicable, has enrolled in the plan. Your base salary and regularly scheduled overtime, excluding overtime resulting from the 19/30 work schedule. The status of an employee who has not been terminated, but is not performing services due to a leave of absence. Exception: Personal Leave of Absence shall not include time during a military leave of absence or leave of absence under the Family and Medical Leave Act. The treatment of disease and injury by mechanical means, such as exercise, heat, light, hydrotherapy and massage (excludes speech therapy, recreational therapy or rehabilitative swimming lessons), and rendered by a physician or physiotherapist. The physiotherapist must be registered, licensed or recognized in accordance with local licensing authorities. The services must be prescribed by a physician, and any claim for plan benefits must be accompanied by a physician s treatment plan outlining type of treatment, frequency and duration. Any change or extension to the treatment plan should be accompanied by an explanation by the physician. The plan may also require periodic updates regarding the treatment plan. Physical therapy does not include educational training or services designed to develop physical function. A duly licensed member of a medical profession who: Has an M.D. or D.O. degree; Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices; and Provides medical services that are within the scope of that license or certificate. This includes a health professional who: Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices; Provides medical services that are within the scope of that license or certificate; Under applicable insurance law, is considered a physician for purposes of this coverage; Has the medical training and clinical expertise suitable to treat your condition; Specializes in psychiatry, if your illness or injury is caused, to any extent, by alcohol abuse, substance abuse or a mental disorder; and Is a physician who is not you or related to you. (continued) 82 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

109 Physician For the life and AD&D options under the Group Life Insurance Plan and for the LTD Plan Placed for adoption, placement for adoption For Employee Medical, Employee Dental, Employee Vision, the EAP and Retiree Medical (Does not apply to domestic partners) Post-service claim Pre-admission testing A person who is: A doctor of medicine, osteopathy, psychology or other legally qualified practitioner of a healing art that the Claims Administrator recognizes or is required to recognize; Licensed to practice in the jurisdiction where care is being given; Practicing within the scope of that license; and Not related to you by blood or marriage. A child (must be available for adoption and under the age of 18) has been placed for adoption with the covered employee in his or her home, whether or not the adoption has become final, as of the date of either (i) an order by a court of competent jurisdiction in the United States is issued placing the child in the home of the covered employee for the purpose of legally adopting the child and imposes a legal obligation on the covered employee for partial or total support of the child, or (ii) a legally binding contract between the covered employee and an authorized placement agency has been signed by both parties that is enforceable in a court of competent jurisdiction (also known as a placement contract ), which the placement contract places the child in the home of the covered employee for the purpose of legally adopting the child and imparts an obligation on the covered employee for partial or total support of the child. A claim for a benefit that was not required to be preapproved before the service was received in order to get the maximum plan benefit. Most claims under the medical and dental plans will be post-service claims. Preliminary tests, such as X-rays and laboratory tests, performed prior to admission on a person who is scheduled for inpatient care or outpatient surgery. Pre-admission testing must be: Related to the performance of a scheduled surgery that s covered by the plan, and performed prior to, and within seven days of, surgery; Ordered by a physician after a condition requiring surgery has been diagnosed and after: Hospital admission for the surgery has been requested by the physician and confirmed by the hospital; or The surgery has been scheduled by the physician, if the surgery is to be performed on an outpatient basis; and Performed in a hospital or a laboratory whose tests results are determined to be acceptable by the hospital or outpatient surgical facility/ambulatory surgical center where the surgery is performed. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 83

110 OTHER INFORMATION Pre-disability earnings Pre-existing condition Premium pay Pre-service claim Preventive medical care Preventive prescription drugs Your base pay, plus regularly scheduled overtime as determined by the company and as in effect on the day before you began your elimination period. Pre-disability earnings may include: Any pay increases you receive during the elimination period; and Contributions you make through a salary reduction agreement with the company to any of the following: A Code Section 401(k) plan; An executive nonqualified deferred compensation arrangement; and Amounts contributed under a Code Section 125 plan. Pre-disability earnings do not include: Overtime resulting from the 19/30 work schedule. Awards and bonuses. Contributions made by the company on your behalf to any deferred compensation arrangement or pension plan. Holiday pay for hourly employees at the refineries. Any other compensation. An injury or illness for which a person has received treatment or services or has taken prescription drug medication during the three months before coverage is effective. There is no pre-existing condition benefit limitation under the medical options. Pay above the normal pay for regular work hours, such as holiday pay, upgrade pay, callout pay, unscheduled overtime and shift differentials. A claim for a benefit that is required to be preapproved before the service is received in order to get the maximum plan benefit. This includes such things as required pre-certification, case management or utilization review, and requests to extend a course of treatment that was previously preapproved. A medical examination or service given by a provider when it is not in connection with the diagnosis, monitoring or treatment of a suspected or identified disease or injury. Not in connection means you have never been treated, diagnosed or suspected to have the identified disease or condition for which the provider is giving the examination or service. Preventive medical care also refers to services based on the preventive medical care guidelines followed by the Claims Administrator. These guidelines may be based on recommendations from nationally recognized organizations, such as the U.S. Preventive Services Task Force. Prescription drug medications that help avoid or prevent reoccurrence of an illness or condition. Medications within a category may change periodically. The Claims Administrator sets preventive prescription drug medications clinical dispensing guidelines. Certain preventive prescription drugs may also be considered a maintenance medication and, in addition, be subject to those plan provisions. (continued) 84 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

111 Primary care physician (PCP) Principal sum Professional counselor Psychiatrist Psychologist A physician responsible for coordinating all care for an individual patient from providing direct care services to referring the patient to specialist and hospital care when necessary. The total amount of AD&D benefit purchased by you and from which certain AD&D benefits are calculated. A person who has completed the necessary education and training to meet the licensing or certification requirements of the governmental body having jurisdiction over such credentialing where the person renders service to a patient. A physician who specializes in the prevention, diagnosis, and treatment of mental illness and substance abuse disorders. A psychiatrist: Must be licensed to practice psychiatry in the state in which his or her practice is located; Must receive additional training and serve a supervised residency in his or her specialty; May also have additional training in a psychiatric specialty, such as child and adolescent psychiatry, geriatric psychiatry, and/or psychoanalysis; and May prescribe medication. A person who is: Licensed or certified as a clinical psychologist by the appropriate governmental authority having jurisdiction over such licensing or certification in the jurisdiction where the person renders service to the patient; or A member or fellow of the American Psychological Association if there s no licensing or certification in the jurisdiction where the person renders service to the patient. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 85

112 OTHER INFORMATION Reasonable and customary (R&C) For Employee Medical, Employee Dental and Retiree Medical Non-network benefits under the Consumer Plan, PPO Plan, Medicare-Eligible PPO Plan and Dental Plan options are paid based on reasonable and customary limits (not applicable to network provider charges). Refer to your certificate of coverage if you are participating in an HMO. For a medically necessary service or supply, the reasonable and customary limit is generally the dollar amount that s the lower of: The provider s charge; or 300% of the Medicare allowable rate for facility charges (inpatient and outpatient) and 225% of the Medicare allowable rate for provider charges for the geographic area where the service was performed. Medicare allowable rates are established and periodically updated by The Centers for Medicare and Medicaid Services (CMS) for payment for services and supplies provided to Medicare enrollees. The Claims Administrator updates these revised rates within 180 days of receiving them from CMS. If a contractual arrangement with the Claims Administrator is established, the reasonable and customary limit is the rate established in such agreement. Absent an established Medicare reimbursement rate or contractual arrangement with the Claims Administrator, the Claims Administrator maintains and periodically updates data for its use in processing claims. The plan sets the percentile for the reasonable and customary fee. Note: For the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan, the Claims Administrator uses an outside profile data source to ensure that there s adequate profile information to support reasonable and customary benefit determination. The reasonable and customary limit for a given procedure in a geographic area based on the first three digits of the U.S. Postal Service ZIP Codes are all grouped and then ranked. If the volume of charges is not sufficient to produce a statistically valid sample, additional three digit ZIP codes are grouped; however, the grouping never crosses state lines. For the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan, in determining the recognized charge for a service or supply that s unusual, not often provided in the area or provided by only a small number of providers in the area, the Claims Administrator may take into account such factors as the: Complexity. Duration. Degree of skill needed. Type of specialty of the provider. Range of services or supplies provided by a facility. Reasonable and customary charge made by providers in other areas. Charge the claims administrator determines to be appropriate based on such factor as the cost of providing the same or similar service or supply and the manner in which the service or supply are made. Charge the claims administrator determines to be the reasonable and customary percentage made for that service or supply. (definition continued on next page) (continued) 86 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

113 Reasonable and customary (R&C) (continued) For Employee Medical, Employee Dental and Retiree Medical Reasonable and customary (R&C) For the Flexible Spending Plan Recurring seasonal employee Referral Regular job Rehabilitation program Example of covered charge: If the provider charges: And the reasonable and customary charge is: $50 $55 $50 $60 $55 $55 The plan will recognize: The plan does NOT cover charges that are over the reasonable and customary limit. In addition, charges that are over the reasonable and customary limit don t count toward satisfying any annual deductible or annual out-of-pocket maximum that may apply to the plan. For the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan, in order for the plan to recognize a provider s fee above the reasonable and customary level as a covered expense, there must be an appeal to the Claims Administrator that verifies that there was something out of the ordinary that warrants the higher charge. To find out whether your provider s charges fall within reasonable and customary limits for a specific service before you receive care, ask your provider for: The amount of the charge; The numeric code that your provider will assign to the service provided; and Your provider s billing office ZIP Code. You should call the Claims Administrator with this information well in advance of receiving the service. The Claims Administrator will let you know whether the charges are within reasonable and customary limits. The dollar amount that is the lower of the provider s charge or the prevailing charge for the same service among providers in the same geographic area is the reasonable and customary amount. A recurring seasonal employee of Phillips 66 employed at Stony Island who is not terminated at the end of the performance of his or her seasonal duties. The process of increasing client awareness of various available resource systems as well as expediting transfer of the client to the appropriate resource. The material duties you regularly perform for the company that provides your pre-disability earnings. A return to full-time or part-time active employment by you in an attempt to enable you to resume gainful employment or service in an occupation for which you are reasonably qualified taking into account your training, experience and past earnings; or Participating in vocational training or physical therapy deemed appropriate by one of the Claims Administrator s rehabilitation coordinators. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 87

114 OTHER INFORMATION Relocation assistance Reserve National Guard Service Resident alien Reimbursement to the participant by the company of moving expenses under the company s current moving policy. Includes: Attending or en route to or from any active duty training of less than sixty (60) days; Attending or en route to or from a service school of any duration; Taking part in any authorized inactive duty training; or Taking part as a unit member in a parade or exhibition authorized by official orders. You are a resident alien as of the first date you are or may be treated as a resident alien as defined by the IRS. Generally, you must satisfy either the green card test or the substantial presence test to be treated as a resident alien. For more information, see IRS Publication 519 U.S. Tax Guide for Aliens. (continued) 88 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

115 Residential treatment center A facility that provides intensive, residential mental health/substance abuse treatment. Residential treatment centers are defined differently for the two types of treatment, as shown below. For mental health treatment Residential Treatment Facility (Center) Services (RTCS) are provided to individuals who require 24-hour treatment and supervision in a safe therapeutic environment. RTCS is a 24-hours-a-day/seven-days-a-week facility-based level of care. RTCS provides individuals with severe and persistent psychiatric disorders therapeutic intervention and specialized programming in a controlled environment that includes a high degree of supervision and structure. RTCS addresses the identified problems through a wide range of diagnostic and treatment services, as well as through training in basic skills, such as social skills and activities of daily living that cannot be provided in a community setting. The services are provided in the context of a comprehensive, multidisciplinary and individualized treatment plan that s frequently reviewed and updated based on the individual s clinical status and response to treatment. This level of care requires at least weekly physician visits. This treatment primarily provides social, psychosocial and rehabilitative training, and focus on family or caregiver reintegration. Active family/significant involvement through family therapy is a key element of treatment and is strongly encouraged unless contraindicated. Discharge planning should begin at admission, including plans for reintegration into the home and community. For substance abuse treatment A facility that: Is established and operated in accordance with any applicable state law to provide a program of medical and therapeutic treatment for alcoholism or drug abuse; Provides a defined program of treatment for substance abuse/chemical dependency and/or behavioral health; Has or maintains a written, specific and detailed regimen requiring full-time residence and full-time participation by the patient; and Provides at least the following basic services: Room and board; Evaluation and diagnosis; Counseling; and Referral and orientation to specialized community resources. A residential treatment center that s part of a hospital will be considered to be a residential treatment center for the purposes of this program. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 89

116 OTHER INFORMATION Room and board charges Same geographical area School Seat belt Service area Covered charges at a semiprivate room rate (if a facility only has private rooms, the billed charge is allowed), excluding physician services or intensive nursing care. Room and board charges include: All charges for medical care and treatment that are made by a hospital at a daily or weekly rate for room and board; and Other hospital services and supplies that are regularly charged by the hospital as a condition of occupancy of the class of accommodations occupied. A new job is considered in the same geographical area as a current job if the distance between the participant s primary residence, as of the date notice of layoff is given, and the location of the new job is no more than 50 miles greater than the distance between the participant s primary residence, as of the date notice of layoff is given, and the location of the current job. For this purpose, the 50-mile provision is determined by reference to Code section 217(c)(1)(A) or a successor Code section and final regulations pertaining to that Code section as in effect on the date of layoff. Such 50-mile provision will be adjusted if and to the extent the 50-mile provision in Code section 217(c)(1)(A) or a successor Code section is adjusted. School includes elementary schools, junior and senior high schools, colleges, universities, and technical, trade and mechanical schools that maintain a regular faculty and curriculum and has a regularly enrolled body of pupils or students in attendance at the place where its educational activities are regularly carried on. It doesn t include on-the-job training courses, correspondence schools and night schools. An unaltered belt, lap restraint or lap and shoulder restraint installed by the manufacturer of the motor vehicle or proper replacement parts installed as required by the motor vehicle s manufacturer s specifications, or a child restraint device that meets the standard of the National Safety Council and is properly secured and used in accordance with applicable state law and installed according to the recommendations of its manufacturer for children of like age and weight. The geographic area, as determined by the Claims Administrator, in which preferred (network) providers for the plan are located. (continued) 90 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

117 Service in the uniformed services Sheltered workshop Skilled nursing care The performance of duty on a voluntary or involuntary basis in the uniformed services under competent authority, including: Active duty. Active duty for training. Initial active duty for training. Full-time National Guard duty. A period for which a person is absent from employment for an examination to determine his or her fitness to perform any of these duties. A period for which a person is absent from employment to perform certain funeral honors duty. Certain duty and training by intermittent disaster relief personnel for the Public Health Service. A school operated by certain tax-exempt organizations, a state, a U.S. possession, a political subdivision of a state or possession, the United States or the District of Columbia, that provides special instruction or training designed to alleviate the individual s disability. Physician-prescribed procedures or activities requiring the presence of, or administration by, a licensed, trained medical provider (including registered nurses, licensed practical nurses and licensed vocational nurses). The procedures or activities must be reasonable and necessary for treatment and care of a disease or injury. Services may include (but aren t limited to) administration of prescribed treatments and medication, observation and assessment of an unstable patient s condition, or providing instructions for self-management of treatment. Services don t include custodial care, transportation, therapy (infusion, physical, occupational and speech), services by a certified or licensed social worker or a person who usually lives with you or a family member. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 91

118 OTHER INFORMATION Skilled nursing facility Social worker Solid organ Spinal manipulation (also chiropractic) Spouse A facility approved by Medicare as a skilled nursing facility. If not approved by Medicare, the facility may be covered, provided it: Is operated in accordance with the applicable laws of the jurisdiction in which it s located; Is operated under the applicable licensing and other laws; Is under the supervision of a licensed physician or registered graduate nurse (R.N.) who is devoted to full-time supervision; Is regularly engaged in providing room and board and continuously provides 24-hours-a-day skilled nursing care of sick and injured persons at the patient s expense during the convalescent stage of an injury or sickness; Maintains a daily medical record of each patient who is under the care of a physician; and Isn t, other than incidentally, a home for the aged, the blind or the deaf, a hotel, a domiciliary care home, a maternity home or a home for alcoholics or drug addicts or the mentally ill. A skilled nursing facility that s part of a hospital will be considered a skilled nursing facility for the purposes of this plan. A person who: Is licensed or certified as a social worker by the appropriate governmental agency having jurisdiction over such licensing or certification in the jurisdiction where the person renders service; or Is a member of the Academy of Certified Social Workers of the National Association of Social Workers, if there s no licensing or certification in the jurisdiction where such person renders services. Organs including the heart, lungs, kidneys, pancreas, intestines and liver. The National Medical Excellence and United Resource Networks programs are designed to help arrange covered care for solid organ and tissue transplants including heart, lung, liver, kidney, pancreas, peripheral stem cell and bone marrow transplants. Services that adjust spinal disorders; includes manipulative (adjustive) treatment or other physical treatment of any condition caused by or related to biomechanical or nerve conduction disorders of the spine. One of the parties of a marriage that is valid in the state or jurisdiction in which the marriage was entered into, regardless of the employee s place of domicile. (continued) 92 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

119 STD absence Store employee Substance abuse For Employee Medical and Retiree Medical Substance abuse For the LTD Plan Absences due solely to an employee s sickness, physical examinations or treatment due to a disability and/or non-occupational illness or injury during such period of time as the employee would have otherwise been performing regularly scheduled work. STD absences also include physician-directed absences during or after a pregnancy which begin the date the physician determines the employee is no longer able to work and ends when the physician releases the employee to return to work. STD absences do not include routine wellness examinations. Any absences that might otherwise be considered STD absences but that occur during or extend into such period of time when the employee is absent due to a paid or unpaid absence (e.g., vacation, community service, etc.) or a leave of absence-labor Dispute are not covered by this plan. Employee in a job classified as retail marketing store (including store manager and store manager in training) in the personnel systems of the employer. The physiological and psychological abuse of, or addiction to, a controlled drug or substance, or to alcohol. Dependence upon tobacco, nicotine and caffeine aren t included in this definition. The pattern of pathological use of alcohol or other psychoactive drugs and substances characterized by: Impairments in social and/or occupational functioning; Debilitating physical condition; Inability to abstain from or reduce consumption of the substance; or The need for daily substance use to maintain adequate functioning. Substance includes alcohol and drugs but excludes tobacco and caffeine. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 93

120 OTHER INFORMATION Successor employer Support For Employee Medical, Employee Dental, Employee Vision, the Flexible Spending Plan, the EAP and Retiree Medical Support For the Group Life Insurance Plan Terminally ill One or more unrelated entity(ies) that: Purchases assets from the company or from a member of the employer; or Subsequently purchases assets from a successor employer as defined in the item above where such subsequent purchase is in connection with a corporate event; or Purchases stock of an entity from the company or from a member of the employer; or Forms a joint venture with the company or with a member of the employer; or Purchases an interest in a joint venture from the company or a member of the employer; or Assumes the role of operator of a joint venture or business for which the company had been the operator just prior to that assumption; or Provides service to the employer that was formerly provided by employees of the company or a member of the employer; and Offers employment to one or more participants in connection with a corporate event. For purposes of this definition unrelated entity means a person, company or other legal entity that is not in the affiliated group. Refers to providing more than one-half support of an individual s total support. To make this determination, you must compare the amount of support you provide with the amount of support the other individual receives from all sources, including Social Security, welfare payments, the support you provide and the support the individual supplies for himself or herself. Support includes items and services such as food, shelter, clothing, medical and dental care and education. For an eligible child who s a full-time student, scholarships received for study at a school are excluded from the support test. For an eligible child who s disabled, income received for the performance of services at a sheltered workshop are excluded from the support test, provided the: Availability of medical care is the main reason the disabled child is at the workshop; and Income comes solely from activities at the workshop that are incidental to medical care. If you believe you might provide more than one-half of an individual s support, you should use the support worksheet in IRS Publication 501 Exemptions, Standard Deduction and Filing Information. Refers to providing more than one-half support of an individual s total support. To make this determination, you must compare the amount of support you provide with the amount of support the other individual receives from all sources, including Social Security, welfare payments, the support you provide and the support the individual supplies for himself or herself. Certified by a physician as having a life expectancy, due to illness, of 24 months or less. (continued) 94 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

121 Transitional duty Uniformed services Urgent care Urgent care claim A position that has less than the full-time work schedule you had prior to your disability or does not have all the duties of the job you had prior to your disability and that has been approved by your supervisor and been made available to you. The Armed Forces, the Army National Guard and the Air National Guard when engaged in active duty for training, inactive duty for training, or full-time National Guard duty (i.e., pursuant to order issued under United States federal law), the commissioned corps of the Public Health Service, and any other category of persons designated by the president in time of war or national emergency. Services that are medically necessary and immediately required because of a sudden illness, injury or condition that: Is severe enough to require prompt medical attention to avoid serious deterioration of your health; Includes a condition which would subject you to severe pain that could not be adequately managed without urgent care or treatment; Does not require the level of care provided in the emergency room of a hospital; and Requires immediate outpatient medical care that cannot be postponed until your physician becomes reasonably available. A medical or dental pre-service claim in a situation where delaying a decision on the claim until the usual deadline: Could seriously jeopardize your life or health or your ability to regain maximum function; or Would, in the opinion of a physician who knows your medical condition, subject you to severe and unmanageable pain. The plan will treat a claim as an urgent care claim if the physician or dentist treating you advises the plan that the claim satisfies the urgent care criteria. USERRA The Uniformed Services Employment and Reemployment Rights Act of 1994, as amended. This is a federal act that provides for continuation of medical and dental coverage, the Flexible Spending Plan s Health Care Flexible Spending Account and the Employee Assistance Plan for employees and covered dependents who, under certain circumstances related to uniformed service, would otherwise lose their group health coverage. U.S. expatriate (expat) Valid beneficiary designation For the Group Life Insurance Plan An employee on the direct U.S. dollar payroll working for the company outside the United States on a temporary assignment and designated by the company as a U.S. expatriate. A Claims Administrator-approved form for the applicable plan that s completed either online at or when the required information is given by phone to the Benefits Center. (continued) OTHER INFORMATION PHILLIPS 66 BENEFITS FOR LIFE 95

122 OTHER INFORMATION Walk-in clinic Weekly pay, week s pay Work days Workplace modification For the LTD Plan Workweek Years of service For the STD Plan Years of service For the Severance Pay Plan Health care facilities, typically staffed by nurse practitioners and/or physician assistants, also have a physician on call during all hours of operation and provide limited primary care for unscheduled, non-emergency illnesses and injuries. Walk-in clinics are not designed to be an alternative for primary care providers, but rather offer a quick alternative for common ailments such as strep throat, seasonal allergies and certain immunizations administered within the scope of the clinic s license. If a participant is a salaried employee, the participant s weekly pay is equal to the participant s regular monthly base salary rate at the date of layoff, including any pay for regularly scheduled overtime but excluding overtime due to the 19/30 program, divided by A participant s regular monthly base salary rate shall not include bonuses, variable pay or other special or premium pay. If a participant is an hourly-paid employee, the participant s weekly pay is equal to the participant s regular base pay rate for the participant s regularly scheduled workweek, including any pay for regularly scheduled overtime but excluding overtime due to the 19/30 program, as of the date of layoff. A participant s regular base pay rate shall not include shift differentials, temporary or irregular overtime payments, bonuses, variable pay, or any other special or premium pay. Further, weekly pay shall be determined without regard to reduction for base military pay received while on military leave and without regard to reductions for state-paid disability payments or workers compensation payments. For nonexempt employees: Regularly scheduled working days. For exempt employees: Days that they are normally and regularly expected to work. A change in your work environment, or in the way a job is performed, to allow you to perform, while disabled, the essential duties of your job. For nonexempt employees: The number of regularly scheduled hours in a period of seven consecutive days during which the employee is normally and regularly scheduled to be at work. For exempt employees: The number of days in a period of seven consecutive days during which the employee is normally and regularly expected to be at work. The number of full years of an employee s continuous service completed during the calendar year in which the benefits are requested as determined by the earlier of the employee s service award entry date (SAED) or vacation eligibility date (VED). An experienced exempt or non-exempt hire may have an earlier VED due to recognized related experience. (See the U.S. Service Recognition Policy.) The full years of recognized continuous service, from the participant s Service Award Entry Date (SAED), or from the participant s Severance Service Date (SSD) if applicable, to the date of layoff, with the SAED, SSD and the years of recognized continuous service determined under the Service Recognition Policy of the company. However, after the participant has reached his or her first anniversary date, the participant s service will be recognized up to the anniversary date (if such date is after the participant s date of layoff) in the calendar year in which the participant is laid off. 96 PHILLIPS 66 BENEFITS FOR LIFE OTHER INFORMATION

123 UPDATE: Other Information Summary of Material Modifications This is a summary of material modification ( SMM ) to the Phillips 66 Other Information booklet, as required by law. This SMM and the separate Other Information booklet together are an important part of the summary plan description ( SPD ) for each of the health and welfare benefit plans available to Phillips 66 employees and retirees. This SMM, when combined with the Other Information booklet and each respective health and welfare plan booklet, summarizes the terms of the plan, including amendments through January 1, 2015, and advises you of changes to your SPD. Please read this notice and keep a copy of it in the Updates pocket of your Other Information booklet. HEALTHNET HMO IS ELIMINATED Effective January 1, 2015, all references to HealthNet HMO are deleted. CHANGES TO THE PRESCRIPTION DRUG CLAIMS ADMINISTRATOR Effective January 1, 2015, CVS/caremark replaces Express Scripts, Inc. as the Plan s prescription drug claims administrator. First level appeals should be filed at: CVS Caremark Appeals Department, MC109 P.O. Box Phoenix, AZ Fax: If your appeal is urgent (that is, your health is in serious jeopardy or, in the opinion of your doctor, you will experience pain that cannot be adequately controlled while you wait for a decision on your appeal), you or your authorized representative may request an expedited appeal by calling Customer Care at or by faxing your appeal to CVS/caremark s group number is RX1048. Receipt of this information does not guarantee eligibility. Please refer to the summary plan description (SPD) and any summaries of material modifications (SMMs) for details, including information regarding eligibility, benefits provided under the plan, when coverage begins and ends, claims procedures and your legal rights. Phillips 66 reserves the right to amend, change or terminate the plans, any underlying contract or any other program, at any time without notice, at its sole discretion, according to the terms of the plan. February OTHINFOSMM1

124 UPDATE: Other Information Summary of Material Modifications This is a summary of material modifications ( SMM ) to the Phillips 66 Other Information booklet. This SMM (and any previously issued Other Information booklet SMMs) and the separate Other Information booklet together are an important part of the summary plan description ( SPD ) for each of the health and welfare benefit plans available to Phillips 66 employees and retirees. The SMMs, when combined with the Other Information booklet and each respective health and welfare plan booklet, summarize the terms of the plan, including amendments through January 1, 2016, and advise you of changes to your SPDs. Please read this notice and keep a copy of it in the Updates pocket of your Other Information booklet. PLAN ADMINISTRATION CHANGES Effective August 12, 2015, all references in the Other Information booklet to HR Shared Services or Manager, HR Shared Services are replaced with HR Operations or Manager, HR Operations, respectively. Contact information is: Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK (918) All references to Value Options are replaced with Beacon Health Options. Additionally, Beacon Health Options replaces Manager, HR Shared Services as the Appeals Administrator for mental health and substance abuse second level appeals for the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan. Contact information is: Administrative Appeal Clinical Appeal Phillips 66 Appeals Phillips 66 Appeals c/o Beacon Health Options c/o Beacon Health Options Attn: Appeals and Grievance Attn: Appeals and Grievances, Coordinator National Peer Advisory Services P.O. Box C Sunrise Valley Drive Latham, NY Reston, VA (866) (continued) 1 January 2016

125 UPDATE: Other Information Summary of Material Modifications Effective November 2, 2015, the Manager, HR Operations replaces the Manager, Benefits as the Plan Administrator and Appeals Administrator for short-term disability benefits under the Phillips 66 Disability Plan. All references to Manager, Benefits are replaced with Manager, HR Operations. Contact information is: Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK (918) Effective November 2, 2015, the Manager, Total Rewards replaces the Manager, Benefits as the Plan Administrator for the Phillips 66 Severance Pay Plan. All references to Manager, Benefits are replaced with Manager, Total Rewards. Contact information is: Manager, Total Rewards Phillips 66 Company c/o Total Rewards Department P.O. Box 4428 Houston, TX (832) Effective January 1, 2016, all references to the Severance Pay Plan Committee are replaced with the Benefits Committee. Contact information is: Benefits Committee Phillips 66 Company P.O. Box 4428 Houston, TX (832) Receipt of this information does not guarantee eligibility. Please refer to the summary plan description (SPD) and any summaries of material modification (SMMs) for details, including information regarding eligibility, benefits provided under the plan, when coverage begins and ends, claims procedures and your legal rights. Phillips 66 reserves the right to amend, change or terminate the plans, any underlying contract or any other program, at any time without notice, at its sole discretion, according to the terms of the plan. 2 January OTHINFOSMM1

126 UPDATE: Other Information Summary of Material Modifications This is a summary of material modification ( SMM ) to the Phillips 66 Other Information booklet. This SMM (and any previously issued Other Information booklet SMMs) and the separate Other Information booklet together are an important part of the summary plan description ( SPD ) for each of the health and welfare benefit plans available to Phillips 66 employees and retirees. The SMMs, when combined with the Other Information booklet and each respective health and welfare plan booklet, summarize the terms of the plan, including amendments through January 1, 2017, and advise you of changes to your SPDs. Please read this notice and keep a copy of it in the Updates pocket of your Other Information booklet. PLAN ADMINISTRATION CHANGES All references to Beacon Health Options are removed. The contact information for first level mental health and substance abuse appeals for the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan is: For Aetna: Medical Claims Administrator Aetna, Inc. National Account CRT P.O. Box Lexington, KY (855) For Blue Cross Blue Shield of Texas: Attn: Utilization Management Appeals Blue Cross Blue Shield of Texas P.O. Box Dallas, TX Phone: (888) Fax: (877) The contact information for second level mental health and substance abuse appeals for the Consumer Plan, PPO Plan and Medicare-Eligible PPO Plan is: Phillips 66 Plan Administrator Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK (918) (continued) 1 January 2017

127 UPDATE: Other Information Summary of Material Modifications The contact information for first level Employee Assistance Plan (EAP) appeals is: Aetna Resources for Living 151 Farmington Ave, RSAA Appeals 1250 Hartford, CT This communication may contain information regarding certain Phillips 66 compensation and benefits. The summary plan descriptions for the various benefit plans and other relevant terms and conditions provide more detailed information. Receipt of this communication does not guarantee eligibility for benefits or any other form of compensation. Phillips 66 reserves the right to correct any errors. If the information provided by this communication conflicts with the plan documents, the plan documents will prevail. Phillips 66 also reserves the right to amend, change or terminate its plans, any underlying contract or any other policy or program, at any time without notice, at its sole discretion. 2 January OTHINFOSMM1